Patent Application
20220288199
The instant application contains a Sequence Listing which has been submitted electronically in ASCII format and is hereby incorporated by reference in its entirety. Said ASCII copy, created on Jul. 19, 2021, is named 01183-0031-00US_ST25.txt and is 39,719 bytes in size.
This disclosure relates to the field of therapeutic RNA to treat solid tumor cancers, including, for example, in subjects that have failed, or become intolerant, resistant, or refractory to an anti-programmed cell death 1 (PD-1) or anti-programmed cell death 1 ligand (PD-L1) therapy, including subjects with acquired or innate resistance to an anti-programmed cell death 1 (PD-1) or anti-programmed cell death 1 ligand (PD-L1) therapy, and subjects with advanced-stage or metastatic solid tumors.
The National Cancer Institute defines solid tumors as abnormal masses of tissue that do not normally contain cysts or liquid areas. Solid tumors can be physically located in any tissue or organ including the ovary, breast, colon, and other tissues, and include melanoma, cutaneous squamous cell cancer (CSCC), squamous cell carcinoma of the head and neck (HNSCC), non-small cell lung cancer, kidney cancer, head and neck cancer, thyroid cancer, colon cancer, liver cancer, ovarian cancer, breast cancer.
Immune checkpoint blockade, such as with anti-PD-1 and anti-PD-L1 therapy elicits anticancer responses in the clinic, however a large proportion of patients do not benefit from treatment. Several mechanisms of innate and acquired resistance to checkpoint blockade have been defined and include mutations of MHC I and IFNγ signaling pathways. See, e.g., Sade-Feldman et al. (2017) Nature Communications 8: 1136; see, also, Sharma et al. (2017) Cell 168: 707-723.
Advanced stage solid tumor cancers are particularly difficult to treat. Current treatments include surgery, radiotherapy, immunotherapy and chemotherapy. Surgery alone may be an appropriate treatment for small localized tumors, but large invasive tumors may be unresectable by surgery. Other common treatments such as radiotherapy and chemotherapy are associated with undesirable side effects and damage to healthy cells.
While surgery and current therapies sometimes are able to kill the bulk of the solid tumor, additional cells (including potentially cancer stem cells) may survive therapy. These cells, over time, can form a new tumor leading to cancer recurrence. In spite of multimodal conventional therapies, disease-free survival is less than 25% for many types of solid tumors. Solid tumors that are resistant to multi-modal therapy or that have recurred following therapy are even more difficult to treat, and long-term survival is less than 10%. In particular, there is high need for patients who failed immunotherapies, for example, using monoclonal antibodies against anti-programmed cell death protein 1 or its ligand (anti-PD-1 or anti-PD-L1 therapy).
Disclosed herein are compositions, uses, and methods that can overcome present shortcomings in treatment of solid tumors, such as advanced-stage, unresectable, or metastatic solid tumor cancers, including in subjects that have failed, or become intolerant, resistant, or refractory to an anti-programmed cell death 1 (PD-1) or anti-programmed cell death 1 ligand (PD-L1) therapy. Administration of therapeutic RNAs as disclosed herein can reduce tumor size, prolong time to progressive disease, and/or protect against metastasis and/or recurrence of the tumor and ultimately extend survival time.
Provided herein, inter alia, are methods of treating a subject having a solid tumor cancer, comprising administering an effective amount of RNAs comprising RNA encoding an IL-12sc protein, RNA encoding an IL-15 sushi protein, RNA encoding an IFNα protein, and RNA encoding a GM-CSF protein, and administering an effective amount of an anti-programmed cell death 1 (PD-1) antibody, wherein the subject has failed, or become intolerant, resistant, or refractory to an anti-programmed cell death 1 (PD-1) or anti-programmed cell death 1 ligand (PD-L1) therapy.
In some embodiments, methods of treating a solid tumor cancer in a subject that has failed, or become intolerant, resistant, or refractory to an anti-programmed cell death 1 (PD-1) or anti-programmed cell death 1 ligand (PD-L1) therapy are provided, comprising administering an effective amount of RNAs comprising RNA encoding an IL-12sc protein, RNA encoding an IL-15 sushi protein, RNA encoding an IFNα protein, and RNA encoding a GM-CSF protein and administering an effective amount of an anti-programmed cell death 1 (PD-1) antibody, to a subject that has failed, or become intolerant, resistant, or refractory to an anti-programmed cell death 1 (PD-1) or anti-programmed cell death 1 ligand (PD-L1) therapy.
Methods of treating a subject having anti-PD-1 and/or anti-PD-L1 resistant solid tumor cancer are provided, comprising administering an effective amount of RNAs comprising RNA encoding an IL-12sc protein, RNA encoding an IL-15 sushi protein, RNA encoding an IFNα protein, and RNA encoding a GM-CSF protein and administering an effective amount of an anti-programmed cell death 1 (PD-1) antibody to a subject that has an anti-PD-1 and/or anti-PD-L1 resistant solid tumor cancer.
Encompassed herein are methods of treating a subject having a solid tumor cancer with acquired resistance to anti-PD-1 and/or anti-PD-L1 therapy comprising administering an effective amount of RNAs comprising RNA encoding an IL-12sc protein, RNA encoding an IL-15 sushi protein, RNA encoding an IFNα protein, and RNA encoding a GM-CSF protein and administering an effective amount of an anti-programmed cell death 1 (PD-1) antibody to a subject that has a solid tumor cancer with acquired resistance to anti-PD-1 and/or anti-PD-L1 therapy.
In some embodiments, methods of treating a subject having a solid tumor cancer with innate resistance to anti-PD-1 and/or anti-PD-L1 therapy are provided, comprising administering an effective amount of RNAs comprising RNA encoding an IL-12sc protein, RNA encoding an IL-15 sushi protein, RNA encoding an IFNα protein, and RNA encoding a GM-CSF protein and administering an effective amount of an anti-programmed cell death 1 (PD-1) antibody to a subject that has a solid tumor cancer with innate resistance to anti-PD-1 and/or anti-PD-L1 therapy.
Embodiments provided herein are not limited by any scientific theory regarding intolerance, resistance, or refraction.
In some embodiments, the intolerance, resistance, refraction (including acquired and innate resistance) to an anti-PD-1 and/or anti-PD-1 therapy results from a cancer cell comprising a partial or total loss of beta-2-microglobulin (B2M) function. In some embodiments, a subject has a cancer cell comprising a partial or total loss of beta-2-microglobulin (B2M) function. In some embodiments, the cancer cell has a partial loss of B2M function. In some embodiments, the cancer cell has a total loss of B2M function. In some embodiments, the partial or total loss of B2M function is assessed by comparing a cancer cell to a non-cancer cell from the same subject, optionally wherein the non-cancer cell is from the same tissue from which the cancer cell was derived. In some embodiments, the cancer cell is in a solid tumor that comprises cancer cells with normal B2M function. In some embodiments, the cancer cell is in a solid tumor in which 25% or more of the cancer cells have a partial or total loss in B2M function. In some embodiments, the cancer cell is in a solid tumor in which 50% or more of the cancer cells have a partial or total loss in B2M function. In some embodiments, the cancer cell is in a solid tumor in which 75% or more of the cancer cells have a partial or total loss in B2M function. In some embodiments, the cancer cell is in a solid tumor in which 95% or more of the cancer cells have a partial or total loss in B2M function. In some embodiments, the solid tumor as a whole (e.g., as assessed in a biopsy taken from the solid tumor) has a partial or total loss of B2M function compared to normal cells or tissue from which the solid tumor is derived. In some embodiments, the subject comprises (e.g., the partial or total loss of function results from) a mutation in the B2M gene. The mutation may be a substitution, insertion, or deletion. In some embodiments, the B2M gene comprises a loss of heterozygosity (LOH).
In some embodiments, the mutation is a frameshift mutation. In some embodiments, the frameshift mutation is in exon 1 of B2M. In some embodiments, the frameshift mutation comprises p.Leu13fs and/or p.Ser14fs. In some embodiments, the subject has a reduced level of B2M protein as compared to a subject without a partial or total loss of B2M function.
In some instances, the solid tumor (e.g., cancer cells within the solid tumor) have a reduced level of cell-surface expressed (also referred to herein as “surface expressed”) major histocompatibility complex class I (MHC I). In some embodiments, a solid tumor sample (e.g., a biopsy comprising cancer cells of the solid tumor) has a reduced level of cell-surface expressed MHC I as compared to a control, optionally wherein the control is a corresponding non-cancerous sample from the same subject. In some embodiments, the level of MHC I expressed on the surface of cancer cells in the solid tumor is reduced as a result of a mutation in a B2M gene. In some embodiments, a subject has a cancer cell comprising a reduced level of surface expressed MHC I. In some embodiments, the cancer cell has no surface expressed MHC I. In some embodiments, the reduced level of surface expressed MHC I is assessed by comparing a cancer cell to a non-cancer cell from the same subject, optionally wherein the non-cancer cell is from the same tissue from which the cancer cell was derived. In some embodiments, the cancer cell is in a solid tumor that comprises cancer cells with a normal level of surface expressed MHC I. In some embodiments, the cancer cell is in a solid tumor in which 25% or more of the cancer cells have a reduced level of surface expressed MHC I. In some embodiments, the cancer cell is in a solid tumor in which 50% or more of the cancer cells have a reduced level of surface expressed MHC I. In some embodiments, the cancer cell is in a solid tumor in which 75% or more of the cancer cells have a reduced level of surface expressed MHC I. In some embodiments, the cancer cell is in a solid tumor in which 95% or more of the cancer cells have a reduced level of surface expressed MHC I. In some embodiments, the solid tumor as a whole (e.g., as assessed in a biopsy taken from the solid tumor) has a reduced level of surface expressed MHC I compared to normal cells or tissue from which the solid tumor is derived.
In some embodiments, methods for treating a subject having an advanced-stage, unresectable, or metastatic solid tumor cancer are provided comprising administering an effective amount of RNAs comprising RNA encoding an IL-12sc protein, RNA encoding an IL-15 sushi protein, RNA encoding an IFNα protein, and RNA encoding a GM-CSF protein and administering an effective amount of an anti-programmed cell death 1 (PD-1) antibody to a subject that has an advanced-stage, unresectable, or metastatic solid tumor cancer.
In some embodiments, the subject has failed, or become intolerant, resistant, or refractory to an anti-programmed cell death 1 (PD-1) therapy. In some embodiments, the subject has failed, or become intolerant, resistant, or refractory to an anti-programmed cell death 1 ligand (PD-L1) therapy.
In some embodiments, the subject has failed an anti-programmed cell death 1 (PD-1) therapy or anti-programmed cell death 1 ligand (PD-L1) therapy.
In some embodiments, the subject has become intolerant to an anti-programmed cell death 1 (PD-1) or anti-programmed cell death 1 ligand (PD-L1) therapy.
In some embodiments, the subject has become resistant to an anti-programmed cell death 1 (PD-1) and/or anti-programmed cell death 1 ligand (PD-L1) therapy.
In some embodiments, the subject has become refractory to an anti-programmed cell death 1 (PD-1) or anti-programmed cell death 1 ligand (PD-L1) therapy. In some embodiments, the refractory or resistant cancer is one that does not respond to a specified treatment. In some embodiments, the refraction occurs from the very beginning of treatment. In some embodiments, the refraction occurs during treatment.
In some embodiments, the cancer is resistant before treatment begins. In some embodiments, the subject has a cancer that does not respond to the anti-programmed cell death 1 (PD-1) and/or anti-programmed cell death 1 ligand (PD-L1) therapy. In some embodiments, the subject has a cancer that is becoming refractory or resistant to a specified treatment. In some embodiments, the specified treatment is as an anti-PD1 therapy. In some embodiments, the specified treatment is as an anti-PD-L1 therapy. In some embodiments, the subject has become less responsive to the therapy since first receiving it. In some embodiments, the subject has not received the therapy, but has a type of cancer that does not typically respond to the therapy.
In some embodiments, the subject is human.
In some embodiments, the subject has not been treated previously with an anti-PD-1 or anti-PD-L1 therapy. In some embodiments, the solid tumor cancer is one in which an anti-PD-1 or anti-PD-L1 therapy is not routinely used.
In some embodiments, the subject has a metastatic solid tumor. In some embodiments, the subject has a non-metastatic solid tumor. In some embodiments, the subject has an unresectable solid tumor. In some embodiments, the subject has a metastatic and unresectable solid tumor. In some embodiments, the subject has a non-metastatic and unresectable solid tumor.
In some embodiments, the solid tumor is an epithelial tumor, prostate tumor, ovarian tumor, renal cell tumor, gastrointestinal tract tumor, hepatic tumor, colorectal tumor, tumor with vasculature, mesothelioma tumor, pancreatic tumor, breast tumor, sarcoma tumor, lung tumor, colon tumor, melanoma tumor, small cell lung tumor, neuroblastoma tumor, testicular tumor, carcinoma tumor, adenocarcinoma tumor, seminoma tumor, retinoblastoma, cutaneous squamous cell carcinoma (CSCC), squamous cell carcinoma for the head and neck (HNSCC), head and neck cancer, osteosarcoma tumor, cutaneous squamous cell cancer (CSCC), non-small cell lung cancer, kidney tumor, thyroid tumor, liver tumor, or other solid tumors amenable to intratumoral injection.
In some embodiments, the solid tumor is a lymphoma, including Non-Hodgkin lymphoma or Hodgkin lymphoma.
In some embodiments, the solid tumor cancer is melanoma. In some embodiments, the melanoma is uveal melanoma or mucosal melanoma. In some embodiments, the solid tumor cancer is melanoma, optionally uveal melanoma or mucosal melanoma, and comprises superficial, subcutaneous and/or lymph node metastases amenable for intratumoral injection.
In some embodiments, intratumoral injection comprises injection into a solid tumor metastasis within a lymph node. In some embodiments, intratumoral injection comprises injection into a lymphoma tumor within a lymph node. In some embodiments, intratumoral injection comprises injection into a primary or secondary solid tumor that is within 10 cm of the subject's skin surface. In some embodiments, intratumoral injection comprises injection into a primary or secondary solid tumor that is within 5 cm of the subject's skin surface. In some embodiments, intratumoral injection comprises injection into a cutaneous solid tumor. In some embodiments, the cutaneous solid tumor is a metastasis. In some embodiments, the cutaneous solid tumor is a skin cancer. In some embodiments, the cutaneous solid tumor is not a skin cancer. In some embodiments, intratumoral injection comprises injection into a subcutaneous solid tumor. In some embodiments, the subcutaneous solid tumor is a metastasis. In some embodiments, the subcutaneous solid tumor is a skin cancer. In some embodiments, the subcutaneous solid tumor is not a skin cancer.
In some embodiments, the solid tumor is an epithelial tumor. In some embodiments, the solid tumor is a prostate tumor. In some embodiments, the solid tumor is an ovarian tumor. In some embodiments, the solid tumor is a renal cell tumor. In some embodiments, the solid tumor is a gastrointestinal tract tumor. In some embodiments, the solid tumor is a hepatic tumor. In some embodiments, the solid tumor is a colorectal tumor. In some embodiments, the solid tumor is a tumor with vasculature. In some embodiments, the solid tumor is a mesothelioma tumor. In some embodiments, the solid tumor is a pancreatic tumor. In some embodiments, the solid tumor is a breast tumor. In some embodiments, the solid tumor is a sarcoma tumor. In some embodiments, the solid tumor is a lung tumor. In some embodiments, the solid tumor is a colon tumor. In some embodiments, the solid tumor is a melanoma tumor. In some embodiments, the solid tumor is a small cell lung tumor. In some embodiments, the solid tumor is non-small cell lung cancer tumor. In some embodiments, the solid tumor is a neuroblastoma tumor. In some embodiments, the solid tumor is a testicular tumor. In some embodiments, the solid tumor is a carcinoma tumor. In some embodiments, the solid tumor is an adenocarcinoma tumor. In some embodiments, the solid tumor is a seminoma tumor. In some embodiments, the solid tumor is a retinoblastoma. In some embodiments, the solid tumor is a cutaneous squamous cell carcinoma (CSCC). In some embodiments, the solid tumor is a squamous cell carcinoma for the head and neck (HNSCC). In some embodiments, the solid tumor is HNSCC. In some embodiments, the solid tumor is head and neck cancer. In some embodiments, the solid tumor is an osteosarcoma tumor. In some embodiments, the solid tumor is kidney cancer. In some embodiments, the solid tumor is thyroid cancer. In some embodiments, the solid tumor is anaplastic thyroid cancer (ATC). In some embodiments, the solid tumor is liver cancer. In some embodiments, the solid tumor is a colon tumor. In some embodiments, the solid tumor is any two of the above. In some embodiments, the solid tumor is any two or more of the above.
In some embodiments, the solid tumor is lymphoma. In some embodiments, the solid tumor is Non-Hodgkin lymphoma. In some embodiments, the solid tumor is Hodgkin lymphoma. In some embodiments, the solid tumor lymphoma is not a central nervous system lymphoma.
In some embodiments, the solid tumor cancer is HNSCC. In some embodiments, the solid tumor cancer is mucosal melanoma with only mucosal sites. In some embodiments, the solid tumor cancer is HNSCC and mucosal melanoma with only mucosal sites.
In some embodiments, the solid tumor cancer is uveal melanoma or mucosal melanoma. In some embodiments, the solid tumor cancer is breast cancer. In some embodiments, the solid tumor cancer is breast sarcoma or triple negative breast cancer.
In some embodiments, the RNAs are administered in combination with an anti-PD-1 antibody.
In some embodiments, the subject has more than one solid tumor. In some instances, at least one tumor is resistant, refractory, or intolerant to PD-1 or PD-L1 therapy. In some embodiments, at least one tumor is resistant, refractory, or intolerant to PD-1 or PD-L1 therapy and at least one tumor is not. In some embodiments, where more than one solid tumor is present, both resistant and non-resistant tumors, if present, are successfully treated.
In some embodiments, the solid tumor cancer is stage III, subsets of stage III, stage IV, or subsets of stage IV. In some embodiments, the solid tumor cancer is stage stage IIIC, or stage IV cancer.
In some embodiments, the solid tumor cancer is advanced-stage. In some embodiments, the solid tumor cancer is unresectable. In some embodiments, the solid tumor cancer is advanced-stage and unresectable.
In some embodiments, the solid tumor has spread from its origin to another site in the subject.
In some embodiments, the solid tumor cancer has one or more cutaneous or subcutaneous lesions. In some embodiments, the solid tumor cancer has metastasized. In some embodiments, the solid tumor cancer has metastasized, but is not a skin cancer.
In some embodiments, the subject is without other treatment options.
In some embodiments, the solid tumor cancer is one for which an anti-PD1 or anti-PD-L1 therapy is routinely used, but which has not been treated with the therapy yet.
In some embodiments, the solid tumor cancer is stage IIIB, IIIC, or unresectable stage IV melanoma that is resistant and/or refractory to anti-PD-1 or anti-PD-L1 therapy. In some embodiments, the solid tumor cancer comprises superficial or subcutaneous lesions and/or metastases.
In some embodiments, the subject has measurable disease according to the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria. In some embodiments, the subject has a life expectancy of more than 3 months. In some embodiments, the subject is at least 18 years of age.
In some embodiments, the RNAs are injected intratumorally.
In some embodiments, the RNAs are injected intratumorally only at mucosal sites of the solid tumor cancer.
In some embodiments, the RNAs are administered for about 5 months. In some embodiments, the RNAs are administered once every week. In some embodiments, the RNAs are administered for a maximum of 52 weeks.
In some embodiments, the IFNα protein is an IFNα2b protein.
In some embodiments, the RNA encoding an IL-12sc protein comprises the nucleotide sequence of SEQ ID NO: 17 or 18, or a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the nucleotide sequence of SEQ ID NO: 17 or 18; and/or the IL-12sc protein comprises the amino acid sequence of SEQ ID NO: 14, or an amino acid sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the amino acid sequence of SEQ ID NO:14; and/or the RNA encoding an IL-12sc protein comprises a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the p40 portion of IL-12sc (nucleotides 1-984 of SEQ ID NO: 17 or 18) and at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the p30 portion of IL-12sc (nucleotides 1027-1623 of SEQ ID NO: 17 or 18) and further comprises nucleotides between the p40 and p35 portions encoding a linker polypeptide.
In some embodiments, the RNA encoding an IL-15 sushi protein comprises the nucleotide sequence of SEQ ID NO: 26, or a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the nucleotide sequence of SEQ ID NO: 26; and/or the IL-15 sushi protein comprises the amino acid sequence of SEQ ID NO: 24, or an amino acid sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the amino acid sequence of SEQ ID NO: 24; and/or the RNA encoding an IL-15 sushi protein comprises a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the sushi domain of IL-15 receptor alpha (nucleotides 1-321 of SEQ ID NO: 26) and at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to mature IL-15 (nucleotides 382-729 of SEQ ID NO: 26) and optionally further comprises nucleotides between the sushi domain of IL-15 and the mature IL-15 encoding a linker polypeptide.
In some embodiments, the RNA encoding an IFNα protein comprises the nucleotide sequence of SEQ ID NO: 22 or 23, or a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the nucleotide sequence of SEQ ID NO: 22 or 23 and/or the IFNα protein comprises the amino acid sequence of SEQ ID NO: 19, or an amino acid sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the amino acid sequence of SEQ ID NO: 19.
In some embodiments, the RNA encoding a GM-CSF protein comprises the nucleotide sequence of SEQ ID NO: 29, or a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the nucleotide sequence of SEQ ID NO: 29 and/or the GM-CSF protein comprises the amino acid sequence of SEQ ID NO: 27, or an amino acid sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the amino acid sequence of SEQ ID NO: 27.
In some embodiments, at least one RNA comprises a modified nucleoside in place of at least one uridine. In some embodiments, at least one RNA comprises a modified nucleoside in place of each uridine. In some embodiments, each RNA comprises a modified nucleoside in place of at least one uridine. In some embodiments, each RNA comprises a modified nucleoside in place of each uridine. In some embodiments, the modified nucleoside is independently selected from pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ), and 5-methyl-uridine (m5U). In some embodiments, at least one RNA comprises more than one type of modified nucleoside, wherein the modified nucleosides are independently selected from pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ), and 5-methyl-uridine (m5U). In some embodiments, the modified nucleoside is N1-methyl-pseudouridine (m1ψ).
In some embodiments, at least one RNA comprises the 5′ cap m27,3′-OGppp(m12′-O)ApG (also sometimes referred to as m27,3′OG(5′)ppp(5′)m2′-OApG). In some embodiments, each RNA comprises the 5′ cap m27,3′-OGppp(m12′-O)ApG (also sometimes referred to as m27,3′OG(5′)ppp(5′)m2′-OApG).
In some embodiments, at least one RNA comprises a 5′ UTR comprising a nucleotide sequence selected from the group consisting of SEQ ID NOs: 4 and 6, or a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to a nucleotide sequence selected from the group consisting of SEQ ID NOs: 4 and 6. In some embodiments, each RNA comprises a 5′ UTR comprising a nucleotide sequence selected from the group consisting of SEQ ID NOs: 4 and 6, or a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to a nucleotide sequence selected from the group consisting of SEQ ID NOs: 4 and 6.
In some embodiments, at least one RNA comprises a 3′ UTR comprising the nucleotide sequence of SEQ ID NO: 8, or a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the nucleotide sequence of SEQ ID NO: 8. In some embodiments, each RNA comprises a 3′ UTR comprising the nucleotide sequence of SEQ ID NO: 8, or a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the nucleotide sequence of SEQ ID NO: 8.
In some embodiments, at least one RNA comprises a poly-A tail. In some embodiments, each RNA comprises a poly-A tail. In some embodiments, the poly-A tail comprises at least 100 nucleotides. In some embodiments, the poly-A tail comprises or consists of the poly-A tail shown in SEQ ID NO: 30.
In some embodiments, one or more RNA comprises:
In some embodiments, the poly-A tail comprises or consists of SEQ ID NO: 30.
In some embodiments, treating the solid tumor comprises reducing the size of a tumor or preventing cancer metastasis in a subject.
In some embodiments, the RNAs are administered at the same time. In some embodiments, the RNAs are administered via injection. In some embodiments, the RNAs are mixed together in liquid solution prior to injection.
In some embodiments, the anti-PD1 antibody is cemiplimab, pembrolizumab, nivolumab, MEDI0608, PDR001, PF-06801591, BGB-A317, pidilizumab, TSR-042, AGEN-2034, A-0001, BGB-108, BI-754091, CBT-501, ENUM-003, ENUM-388D4, IBI-308, JNJ-63723283, JS-001, JTX-4014, JY-034, CLA-134, STIA-1110, 244C8, or 388D4. In some embodiments, the anti-PD1 antibody is cemiplimab.
In some embodiments, the anti-PD1 antibody is administered at a dose of about 0.1-600 mg. In some embodiments, the anti-PD1 antibody is administered at a dose of 200 mg. In some embodiments, the anti-PD1 antibody is administered at a dose of 240 mg. In some embodiments, the anti-PD1 antibody is administered at a dose of 350 mg. In some embodiments, the anti-PD1 antibody is administered via injection. In some embodiments, the anti-PD1 antibody is administered intravenously. In some embodiments, the anti-PD-1 antibody is administered once every three weeks. In some embodiments, the RNAs and the anti-PD-1 antibody are administered for about 8 months.
Further embodiments of the present application are as follows:
Further embodiments of the present application are as follows:
Table 1 provides a listing of certain sequences referenced herein.
GGAATAAACTAGTCTCAACACAACATATACAAAACAAACGAATCTCAAGCAATCAAGCATTCTACTTCTATTGCAGCAATTTAAATCA
TTTCTTTTAAAGCAAAAGCAATTTTCTGAAAATTTTCACCATTTACGAACGATAGCC
GGAAUAAACUAGUCUCAACACAACAUAUACAAAACAAACGAAUCUCAAGCAAUCAAGCAUUCUACUUCUAUUGCAGCAAUUUAAAUCA
UUUCUUUUAAAGCAAAAGCAAUUUUCUGAAAAUUUUCACCAUUUACGAACGAUAGCC
AGACGAACTAGTATTCTTCTGGTCCCCACAGACTCAGAGAGAACCCGCCACC
AGACGAACUAGUAUUCUUCUGGUCCCCACAGACUCAGAGAGAACCCGCCACC
CTCGAGCTGGTACTGCATGCACGCAATGCTAGCTGCCCCTTTCCCGTCCTGGGTACCCCGAGTCTCCCCCGACCTCGGGTCCCAGGTA
TGCTCCCACCTCCACCTGCCCCACTCACCACCTCTGCTAGTTCCAGACACCTCCCAAGCACGCAGCAATGCAGCTCAAAACGCTTAGC
CTAGCCACACCCCCACGGGAAACAGCAGTGATTAACCTTTAGCAATAAACGAAAGTTTAACTAAGCTATACTAACCCCAGGGTTGGTC
AATTTCGTGCCAGCCACACCGAGACCTGGTCCAGAGTCGCTAGCCGCGTCGCT
CUCGAGCUGGUACUGCAUGCACGCAAUGCUAGCUGCCCCUUUCCCGUCCUGGGUACCCCGAGUCUCCCCCGACCUCGGGUCCCAGGUA
UGCUCCCACCUCCACCUGCCCCACUCACCACCUCUGCUAGUUCCAGACACCUCCCAAGCACGCAGCAAUGCAGCUCAAAACGCUUAGC
CUAGCCACACCCCCACGGGAAACAGCAGUGAUUAACCUUUAGCAAUAAACGAAAGUUUAACUAAGCUAUACUAACCCCAGGGUUGGUC
AAUUUCGUGCCAGCCACACCGAGACCUGGUCCAGAGUCGCUAGCCGCGUCGCU
MCHQQLVISWFSLVFLASPLVAIWELKEDVYVVELDWYPDAPGEMVVLTCDTPEEDGITWTLDQSSEVLGSGKTLTIQVKEFGDAGQY
TCHKGGEVLSHSLLLLHKKEDGIWSTDILKDQKEPKNKTFLRCEAKNYSGRFTCWWLTTISTDLTFSVKSSRGSSDPQGVTCGAATLS
AERVRGDNKEYEYSVECQEDSACPAAEESLPIEVMVDAVHKLKYENYTSSFFIRDIIKPDPPKNLQLKPLKNSRQVEVSWEYPDTWST
PHSYFSLTFCVQVQGKSKREKKDRVFTDKTSATVICRKNASISVRAQDRYYSSSWSEWASVPCSGSSGGGGSPGGGSSRNLPVATPDP
GMFPCLHHSQNLLRAVSNMLQKARQTLEFYPCTSEEIDHEDITKDKTSTVEACLPLELTKNESCLNSRETSFITNGSCLASRKTSFMM
ALCLSSIYEDLKMYQVEEKTMNAKLLMDPKRQIELDQNMLAVIDELMQALNENSETVPQKSSLEEPDFYKTKIKLCILLHAFRIRAVT
IDRVMSYLNAS
ATGTGTCACCAGCAGTTGGTCATCTCTTGGTTTTCCCTGGTTTTTCTGGCATCTCCCCTCGTGGCCATATGGGAACTGAAGAAAGATG
TTTATGTCGTAGAATTGGATTGGTATCCGGATGCCCCTGGAGAAATGGTGGTCCTCACCTGTGACACCCCTGAAGAAGATGGTATCAC
CTGGACCTTGGACCAGAGCAGTGAGGTCTTAGGCTCTGGCAAAACCCTGACCATCCAAGTCAAAGAGTTTGGAGATGCTGGCCAGTAC
ACCTGTCACAAAGGAGGCGAGGTTCTAAGCCATTCGCTCCTGCTGCTTCACAAAAAGGAAGATGGAATTTGGTCCACTGATATTTTAA
AGGACCAGAAAGAACCCAAAAATAAGACCTTTCTAAGATGCGAGGCCAAGAATTATTCTGGACGTTTCACCTGCTGGTGGCTGACGAC
AATCAGTACTGATTTGACATTCAGTGTCAAAAGCAGCAGAGGGTCTTCTGACCCCCAAGGGGTGACGTGCGGAGCTGCTACACTCTCT
CAPS: p40
GCAGAGAGAGTCAGAGGGGACAACAAGGAGTATGAGTACTCAGTGGAGTGCCAGGAGGACAGTGCCTGCCCAGCTGCTGAGGAGAGTC
domain;
TGCCCATTGAGGTCATGGTGGATGCCGTTCACAAGCTCAAGTATGAAAACTACACCAGCAGCTTCTTCATCAGGGACATCATCAAACC
TGACCCACCCAAGAACTTGCAGCTGAAGCCATTAAAGAATTCTCGGCAGGTGGAGGTCAGCTGGGAGTACCCTGACACCTGGAGTACT
CCACATTCCTACTTCTCCCTGACATTCTGCGTTCAGGTCCAGGGCAAGAGCAAGAGAGAAAAGAAAGATAGAGTCTTCACGGACAAGA
CAPS: p35.
CCTCAGCCACGGTCATCTGCCGCAAAAATGCCAGCATTAGCGTGCGGGCCCAGGACCGCTACTATAGCTCATCTTGGAGCGAATGGGC
ATCTGTGCCCTGCAGTGGCTCTAGCGGAGGGGGAGGCTCTCCTGGCGGGGGATCTAGCAGAAACCTCCCCGTGGCCACTCCAGACCCA
GGAATGTTCCCATGCCTTCACCACTCCCAAAACCTGCTGAGGGCCGTCAGCAACATGCTCCAGAAGGCCAGACAAACTCTAGAATTTT
ACCCTTGCACTTCTGAGGAAATTGATCATGAAGATATCACAAAAGATAAAACCAGCACAGTGGAGGCCTGTTTACCATTGGAATTAAC
CAAGAATGAGAGTTGCCTAAATTCCAGAGAGACCTCTTTCATAACTAATGGGAGTTGCCTGGCCTCCAGAAAGACCTCTTTTATGATG
GCCCTGTGCCTTAGTAGTATTTATGAAGACTTGAAGATGTACCAGGTGGAGTTCAAGACCATGAATGCAAAGCTTCTGATGGATCCTA
AGAGGCAGATCTTTCTAGATCAAAACATGCTGGCAGTTATTGATGAGCTGATGCAGGCCCTGAATTTCAACAGTGAGACTGTGCCACA
AAAATCCTCCCTTGAAGAACCGGATTTTTATAAAACTAAAATCAAGCTCTGCATACTTCTTCATGCTTTCAGAATTCGGGCAGTGACT
ATTGATAGAGTGATGAGCTATCTGAATGCTTCCTGATGA
ATGTGTCACCAGCAGCTGGTGATCTCATGGTTCTCCCTGGTATTTCTGGCATCTCCTCTTGTCGCAATCTGGGAACTGAAGAAAGACG
TGTATGTCGTTGAGCTCGACTGGTATCCGGATGCGCCTGGCGAGATGGTGGTGCTGACCTGTGACACCCCAGAGGAGGATGGGATCAC
TTGGACCCTTGATCAATCCTCCGAAGTGCTCGGGTCTGGCAAGACTCTGACCATACAAGTGAAAGAGTTTGGCGATGCCGGGCAGTAC
ACTTGCCATAAGGGCGGAGAAGTTCTGTCCCACTCACTGCTGCTGCTGCACAAGAAAGAGGACGGAATTTGGAGTACCGATATCCTGA
AAGATCAGAAAGAGCCCAAGAACAAAACCTTCTTGCGGTGCGAAGCCAAGAACTACTCAGGGAGATTTACTTGTTGGTGGCTGACGAC
GATCAGCACCGATCTGACTTTCTCCGTGAAATCAAGTAGGGGATCATCTGACCCTCAAGGAGTCACATGTGGAGCGGCTACTCTGAGC
CAPS: p40
GCTGAACGCGTAAGAGGGGACAATAAGGAGTACGAGTATAGCGTTGAGTGCCAAGAGGATAGCGCATGCCCCGCCGCCGAAGAATCAT
domain;
TGCCCATTGAAGTGATGGTGGATGCTGTACACAAGCTGAAGTATGAGAACTACACAAGCTCCTTCTTCATCCGTGACATCATCAAACC
AGATCCTCCTAAGAACCTCCAGCTTAAACCTCTGAAGAACTCTAGACAGGTGGAAGTGTCTTGGGAGTATCCCGACACCTGGTCTACA
CCACATTCCTACTTCAGTCTCACATTCTGCGTTCAGGTACAGGGCAAGTCCAAAAGGGAGAAGAAGGATCGGGTCTTTACAGATAAAA
CAPS: p35.
CAAGTGCCACCGTTATATGCCGGAAGAATGCCTCTATTTCTGTGCGTGCGCAGGACAGATACTATAGCAGCTCTTGGAGTGAATGGGC
CAGTGTCCCATGTTCAGGGTCATCCGGTGGTGGCGGCAGCCCCGGAGGCGGTAGCTCCAGAAATCTCCCTGTGGCTACACCTGATCCA
GGCATGTTTCCCTGTTTGCACCATAGCCAAAACCTCCTGAGAGCAGTCAGCAACATGCTCCAGAAAGCTAGACAAACACTGGAATTCT
ACCCATGCACCTCCGAGGAAATAGATCACGAGGATATCACTAAGGACAAAACAAGCACTGTCGAAGCATGCCTTCCCTTGGAACTGAC
AAAGAACGAGAGTTGCCTTAATTCAAGAGAAACATCTTTCATTACAAACGGTAGCTGCTTGGCAAGCAGAAAAACATCTTTTATGATG
GCCCTTTGTCTGAGCAGTATTTATGAGGATCTCAAAATGTACCAGGTGGAGTTTAAGACCATGAATGCCAAGCTGCTGATGGACCCAA
AGAGACAGATTTTCCTCGATCAGAATATGCTGGCTGTGATTGATGAACTGATGCAGGCCTTGAATTTCAACAGCGAAACCGTTCCCCA
GAAAAGCAGTCTTGAAGAACCTGACTTTTATAAGACCAAGATCAAACTGTGTATTCTCCTGCATGCCTTTAGAATCAGAGCAGTCACT
ATAGATAGAGTGATGTCCTACCTGAATGCTTCCTGATGA
AUGUGUCACCAGCAGUUGGUCAUCUCUUGGUUUUCCCUGGUUUUUCUGGCAUCUCCCCUCGUGGCCAUAUGGGAACUGAAGAAAGAUG
UUUAUGUCGUAGAAUUGGAUUGGUAUCCGGAUGCCCCUGGAGAAAUGGUGGUCCUCACCUGUGACACCCCUGAAGAAGAUGGUAUCAC
CUGGACCUUGGACCAGAGCAGUGAGGUCUUAGGCUCUGGCAAAACCCUGACCAUCCAAGUCAAAGAGUUUGGAGAUGCUGGCCAGUAC
ACCUGUCACAAAGGAGGCGAGGUUCUAAGCCAUUCGCUCCUGCUGCUUCACAAAAAGGAAGAUGGAAUUUGGUCCACUGAUAUUUUAA
AGGACCAGAAAGAACCCAAAAAUAAGACCUUUCUAAGAUGCGAGGCCAAGAAUUAUUCUGGACGUUUCACCUGCUGGUGGCUGACGAC
AAUCAGUACUGAUUUGACAUUCAGUGUCAAAAGCAGCAGAGGGUCUUCUGACCCCCAAGGGGUGACGUGCGGAGCUGCUACACUCUCU
GCAGAGAGAGUCAGAGGGGACAACAAGGAGUAUGAGUACUCAGUGGAGUGCCAGGAGGACAGUGCCUGCCCAGCUGCUGAGGAGAGUC
UGCCCAUUGAGGUCAUGGUGGAUGCCGUUCACAAGCUCAAGUAUGAAAACUACACCAGCAGCUUCUUCAUCAGGGACAUCAUCAAACC
UGACCCACCCAAGAACUUGCAGCUGAAGCCAUUAAAGAAUUCUCGGCAGGUGGAGGUCAGCUGGGAGUACCCUGACACCUGGAGUACU
CCACAUUCCUACUUCUCCCUGACAUUCUGCGUUCAGGUCCAGGGCAAGAGCAAGAGAGAAAAGAAAGAUAGAGUCUUCACGGACAAGA
CCUCAGCCACGGUCAUCUGCCGCAAAAAUGCCAGCAUUAGCGUGCGGGCCCAGGACCGCUACUAUAGCUCAUCUUGGAGCGAAUGGGC
AUCUGUGCCCUGCAGUGGCUCUAGCGGAGGGGGAGGCUCUCCUGGCGGGGGAUCUAGCAGAAACCUCCCCGUGGCCACUCCAGACCCA
GGAAUGUUCCCAUGCCUUCACCACUCCCAAAACCUGCUGAGGGCCGUCAGCAACAUGCUCCAGAAGGCCAGACAAACUCUAGAAUUUU
ACCCUUGCACUUCUGAGGAAAUUGAUCAUGAAGAUAUCACAAAAGAUAAAACCAGCACAGUGGAGGCCUGUUUACCAUUGGAAUUAAC
CAAGAAUGAGAGUUGCCUAAAUUCCAGAGAGACCUCUUUCAUAACUAAUGGGAGUUGCCUGGCCUCCAGAAAGACCUCUUUUAUGAUG
GCCCUGUGCCUUAGUAGUAUUUAUGAAGACUUGAAGAUGUACCAGGUGGAGUUCAAGACCAUGAAUGCAAAGCUUCUGAUGGAUCCUA
AGAGGCAGAUCUUUCUAGAUCAAAACAUGCUGGCAGUUAUUGAUGAGCUGAUGCAGGCCCUGAAUUUCAACAGUGAGACUGUGCCACA
AAAAUCCUCCCUUGAAGAACCGGAUUUUUAUAAAACUAAAAUCAAGCUCUGCAUACUUCUUCAUGCUUUCAGAAUUCGGGCAGUGACU
AUUGAUAGAGUGAUGAGCUAUCUGAAUGCUUCCUGAUGA
AUGUGUCACCAGCAGCUGGUGAUCUCAUGGUUCUCCCUGGUAUUUCUGGCAUCUCCUCUUGUCGCAAUCUGGGAACUGAAGAAAGACG
UGUAUGUCGUUGAGCUCGACUGGUAUCCGGAUGCGCCUGGCGAGAUGGUGGUGCUGACCUGUGACACCCCAGAGGAGGAUGGGAUCAC
UUGGACCCUUGAUCAAUCCUCCGAAGUGCUCGGGUCUGGCAAGACUCUGACCAUACAAGUGAAAGAGUUUGGCGAUGCCGGGCAGUAC
ACUUGCCAUAAGGGCGGAGAAGUUCUGUCCCACUCACUGCUGCUGCUGCACAAGAAAGAGGACGGAAUUUGGAGUACCGAUAUCCUGA
AAGAUCAGAAAGAGCCCAAGAACAAAACCUUCUUGCGGUGCGAAGCCAAGAACUACUCAGGGAGAUUUACUUGUUGGUGGCUGACGAC
GAUCAGCACCGAUCUGACUUUCUCCGUGAAAUCAAGUAGGGGAUCAUCUGACCCUCAAGGAGUCACAUGUGGAGCGGCUACUCUGAGC
GCUGAACGCGUAAGAGGGGACAAUAAGGAGUACGAGUAUAGCGUUGAGUGCCAAGAGGAUAGCGCAUGCCCCGCCGCCGAAGAAUCAU
UGCCCAUUGAAGUGAUGGUGGAUGCUGUACACAAGCUGAAGUAUGAGAACUACACAAGCUCCUUCUUCAUCCGUGACAUCAUCAAACC
AGAUCCUCCUAAGAACCUCCAGCUUAAACCUCUGAAGAACUCUAGACAGGUGGAAGUGUCUUGGGAGUAUCCCGACACCUGGUCUACA
CCACAUUCCUACUUCAGUCUCACAUUCUGCGUUCAGGUACAGGGCAAGUCCAAAAGGGAGAAGAAGGAUCGGGUCUUUACAGAUAAAA
CAAGUGCCACCGUUAUAUGCCGGAAGAAUGCCUCUAUUUCUGUGCGUGCGCAGGACAGAUACUAUAGCAGCUCUUGGAGUGAAUGGGC
CAGUGUCCCAUGUUCAGGGUCAUCCGGUGGUGGCGGCAGCCCCGGAGGCGGUAGCUCCAGAAAUCUCCCUGUGGCUACACCUGAUCCA
GGCAUGUUUCCCUGUUUGCACCAUAGCCAAAACCUCCUGAGAGCAGUCAGCAACAUGCUCCAGAAAGCUAGACAAACACUGGAAUUCU
ACCCAUGCACCUCCGAGGAAAUAGAUCACGAGGAUAUCACUAAGGACAAAACAAGCACUGUCGAAGCAUGCCUUCCCUUGGAACUGAC
AAAGAACGAGAGUUGCCUUAAUUCAAGAGAAACAUCUUUCAUUACAAACGGUAGCUGCUUGGCAAGCAGAAAAACAUCUUUUAUGAUG
GCCCUUUGUCUGAGCAGUAUUUAUGAGGAUCUCAAAAUGUACCAGGUGGAGUUUAAGACCAUGAAUGCCAAGCUGCUGAUGGACCCAA
AGAGACAGAUUUUCCUCGAUCAGAAUAUGCUGGCUGUGAUUGAUGAACUGAUGCAGGCCUUGAAUUUCAACAGCGAAACCGUUCCCCA
GAAAAGCAGUCUUGAAGAACCUGACUUUUAUAAGACCAAGAUCAAACUGUGUAUUCUCCUGCAUGCCUUUAGAAUCAGAGCAGUCACU
AUAGAUAGAGUGAUGUCCUACCUGAAUGCUUCCUGAUGA
MALTFALLVALLVLSCKSSCSVGCDLPQTHSLGSRRTLMLLAQMRRISLFSCLKDRHDEGFPQEEFGNQFQKAETIPVLHEMIQQIEN
LESTKDSSAAWDETLLDKEYTELYQQLNDLEACVIQGVGVTETPLMEEDSILAVRKYFQRITLYLKEKKYSPCAWEVVRAEIMRSFSL
STNLQESLRSKE
ATGGCCTTGACCTTTGCTTTACTGGTGGCCCTCCTGGTGCTCAGCTGCAAGTCAAGCTGCTCTGTGGGCTGTGATCTGCCTCAAACCC
ACAGCCTGGGTAGCAGGAGGACCTTGATGCTCCTGGCACAGATGAGGAGAATCTCTCTTTTCTCCTGCTTGAAGGACAGACATGACTT
TGGATTTCCCCAGGAGGAGTTTGGCAACCAGTTCCAAAAGGCTGAAACCATCCCTGTCCTCCATGAGATGATCCAGCAGATCTTCAAC
CTTTTCAGCACAAAGGACTCATCTGCTGCTTGGGATGAGACCCTCCTAGACAAATTCTACACTGAACTCTACCAGCAGCTGAATGACC
TGGAAGCCTGTGTGATACAGGGGGTGGGGGTGACAGAGACTCCCCTGATGAAGGAGGACTCCATTCTGGCTGTGAGGAAATACTTCCA
AAGAATCACTCTCTATCTGAAAGAGAAGAAATACAGCCCTTGTGCCTGGGAGGTTGTCAGAGCAGAAATCATGAGATCTTTTTCTTTG
TCAACAAACTTGCAAGAAAGTTTAAGAAGTAAGGAATGATGA
ATGGCCCTGACTTTTGCCCTTCTCGTGGCTTTGTTGGTGCTGAGTTGCAAATCTTCCTGTAGTGTCGGATGTGATCTGCCTCAAACCC
ACAGTCTGGGATCTAGGAGAACACTGATGCTGTTGGCACAGATGAGGAGAATTAGCCTCTTTTCCTGCCTGAAGGATAGACATGACTT
CGGCTTTCCCCAAGAGGAGTTTGGCAATCAGTTCCAGAAAGCGGAAACGATTCCCGTTCTGCACGAGATGATCCAGCAGATCTTCAAC
CTCTTTTCAACCAAAGACAGCTCAGCAGCCTGGGATGAGACACTGCTGGACAAATTCTACACAGAACTGTATCAGCAGCTTAACGATC
TGGAGGCATGCGTGATCCAAGGGGTTGGTGTGACTGAAACTCCGCTTATGAAGGAGGACTCCATTCTGGCTGTACGGAAGTACTTCCA
GAGAATAACCCTCTATCTGAAGGAGAAGAAGTACTCACCATGTGCTTGGGAAGTCGTGAGAGCCGAAATCATGAGATCCTTCAGCCTT
AGCACCAATCTCCAGGAATCTCTGAGAAGCAAAGAGTGATGA
AUGGCCUUGACCUUUGCUUUACUGGUGGCCCUCCUGGUGCUCAGCUGCAAGUCAAGCUGCUCUGUGGGCUGUGAUCUGCCUCAAACCC
ACAGCCUGGGUAGCAGGAGGACCUUGAUGCUCCUGGCACAGAUGAGGAGAAUCUCUCUUUUCUCCUGCUUGAAGGACAGACAUGACUU
UGGAUUUCCCCAGGAGGAGUUUGGCAACCAGUUCCAAAAGGCUGAAACCAUCCCUGUCCUCCAUGAGAUGAUCCAGCAGAUCUUCAAC
CUUUUCAGCACAAAGGACUCAUCUGCUGCUUGGGAUGAGACCCUCCUAGACAAAUUCUACACUGAACUCUACCAGCAGCUGAAUGACC
UGGAAGCCUGUGUGAUACAGGGGGUGGGGGUGACAGAGACUCCCCUGAUGAAGGAGGACUCCAUUCUGGCUGUGAGGAAAUACUUCCA
AAGAAUCACUCUCUAUCUGAAAGAGAAGAAAUACAGCCCUUGUGCCUGGGAGGUUGUCAGAGCAGAAAUCAUGAGAUCUUUUUCUUUG
UCAACAAACUUGCAAGAAAGUUUAAGAAGUAAGGAAUGAUGA
AUGGCCCUGACUUUUGCCCUUCUCGUGGCUUUGUUGGUGCUGAGUUGCAAAUCUUCCUGUAGUGUCGGAUGUGAUCUGCCUCAAACCC
ACAGUCUGGGAUCUAGGAGAACACUGAUGCUGUUGGCACAGAUGAGGAGAAUUAGCCUCUUUUCCUGCCUGAAGGAUAGACAUGACUU
CGGCUUUCCCCAAGAGGAGUUUGGCAAUCAGUUCCAGAAAGCGGAAACGAUUCCCGUUCUGCACGAGAUGAUCCAGCAGAUCUUCAAC
CUCUUUUCAACCAAAGACAGCUCAGCAGCCUGGGAUGAGACACUGCUGGACAAAUUCUACACAGAACUGUAUCAGCAGCUUAACGAUC
UGGAGGCAUGCGUGAUCCAAGGGGUUGGUGUGACUGAAACUCCGCUUAUGAAGGAGGACUCCAUUCUGGCUGUACGGAAGUACUUCCA
GAGAAUAACCCUCUAUCUGAAGGAGAAGAAGUACUCACCAUGUGCUUGGGAAGUCGUGAGAGCCGAAAUCAUGAGAUCCUUCAGCCUU
AGCACCAAUCUCCAGGAAUCUCUGAGAAGCAAAGAGUGAUGA
MAPRRARGCRTLGLPALLLLLLLRPPATRGITCPPPMSVEHADIWVKSYSLYSRERYICNSGFKRKAGTSSLTECVLNKATNVAHWTT
PSLKCIRDPALVHQRPAPPGGGSGGGGSGGGSGGGGSLQNWVNVISDLKKIEDLIQSMHIDATLYTESDVHPSCKVTAMKCELLELQV
ISLESGDASIHDTVENLIILANNSLSSNGNVTESGCKECEELEEKNIKEFLQSFVHIVQMFINTS
ATGGCCCCGCGGCGGGCGCGCGGCTGCCGGACCCTCGGTCTCCCGGCGCTGCTACTGCTGCTGCTGCTCCGGCCGCCGGCGACGCGGG
GCATCACGTGCCCTCCCCCCATGTCCGTGGAACACGCAGACATCTGGGTCAAGAGCTACAGCTTGTACTCCAGGGAGCGGTACATTTG
TAACTCTGGTTTCAAGCGTAAAGCCGGCACGTCCAGCCTGACGGAGTGCGTGTTGAACAAGGCCACGAATGTCGCCCACTGGACAACC
CCCAGTCTCAAATGCATTAGAGACCCTGCCCTGGTTCACCAAAGGCCAGCGCCACCCGGGGGAGGATCTGGCGGCGGTGGGTCTGGCG
CAPS: IL-15
TATTGATGCTACTTTATATACGGAAAGTGATGTTCACCCCAGTTGCAAAGTAACAGCAATGAAGTGCTTTCTCTTGGAGTTACAAGTT
sushi;
ATTTCACTTGAGTCCGGAGATGCAAGTATTCATGATACAGTAGAAAATCTGATCATCCTAGCAAACAACAGTTTGTCTTCTAATGGGA
ATGTAACAGAATCTGGATGCAAAGAATGTGAGGAACTGGAGGAAAAAAATATTAAAGAATTTTTGCAGAGTTTTGTACATATTGTCCA
AATGTTCATCAACACTTCTTGATGA
CAPS:
mature IL-
15
AUGGCCCCGCGGCGGGCGCGCGGCUGCCGGACCCUCGGUCUCCCGGCGCUGCUACUGCUGCUGCUGCUCCGGCCGCCGGCGACGCGGG
GCAUCACGUGCCCUCCCCCCAUGUCCGUGGAACACGCAGACAUCUGGGUCAAGAGCUACAGCUUGUACUCCAGGGAGCGGUACAUUUG
UAACUCUGGUUUCAAGCGUAAAGCCGGCACGUCCAGCCUGACGGAGUGCGUGUUGAACAAGGCCACGAAUGUCGCCCACUGGACAACC
CCCAGUCUCAAAUGCAUUAGAGACCCUGCCCUGGUUCACCAAAGGCCAGCGCCACCCGGGGGAGGAUCUGGCGGCGGUGGGUCUGGCG
GGGGAUCUGGCGGAGGAGGAAGCUUACAGAACUGGGUGAAUGUAAUAAGUGAUUUGAAAAAAAUUGAAGAUCUUAUUCAAUCUAUGCA
UAUUGAUGCUACUUUAUAUACGGAAAGUGAUGUUCACCCCAGUUGCAAAGUAACAGCAAUGAAGUGCUUUCUCUUGGAGUUACAAGUU
AUUUCACUUGAGUCCGGAGAUGCAAGUAUUCAUGAUACAGUAGAAAAUCUGAUCAUCCUAGCAAACAACAGUUUGUCUUCUAAUGGGA
AUGUAACAGAAUCUGGAUGCAAAGAAUGUGAGGAACUGGAGGAAAAAAAUAUUAAAGAAUUUUUGCAGAGUUUUGUACAUAUUGUCCA
AAUGUUCAUCAACACUUCUUGAUGA
MWLQSLLLLGTVACSISAPARSPSPSTQPWEHVNAIQEARRLLNLSRDTAAEMNETVEVISEMFDLQEPTCLQTRLELYKQGLRGSLT
KLKGPLTMMASHYKQHCPPTPETSCATQIITFESEKENLKDFLLVIPFDCWEPVQE
ATGTGGCTCCAGAGCCTGCTGCTCTTGGGCACTGTGGCCTGCTCCATCTCTGCACCCGCCCGCTCGCCCAGCCCCAGCACGCAGCCCT
GGGAGCATGTGAATGCCATCCAGGAGGCCCGGCGTCTGCTGAACCTGAGTAGAGACACTGCTGCTGAGATGAATGAAACAGTAGAAGT
CATCTCAGAAATGTTTGACCTCCAGGAGCCGACCTGCCTACAGACCCGCCTGGAGCTGTACAAGCAGGGCCTGCGGGGCAGCCTCACC
AAGCTCAAGGGCCCCTTGACCATGATGGCCAGCCACTACAAGCAGCACTGCCCTCCAACCCCGGAAACTTCCTGTGCAACCCAGATTA
TCACCTTTGAAAGTTTCAAAGAGAACCTGAAGGACTTTCTGCTTGTCATCCCCTTTGACTGCTGGGAGCCAGTCCAGGAGTGATGA
AUGUGGCUCCAGAGCCUGCUGCUCUUGGGCACUGUGGCCUGCUCCAUCUCUGCACCCGCCCGCUCGCCCAGCCCCAGCACGCAGCCCU
GGGAGCAUGUGAAUGCCAUCCAGGAGGCCCGGCGUCUGCUGAACCUGAGUAGAGACACUGCUGCUGAGAUGAAUGAAACAGUAGAAGU
CAUCUCAGAAAUGUUUGACCUCCAGGAGCCGACCUGCCUACAGACCCGCCUGGAGCUGUACAAGCAGGGCCUGCGGGGCAGCCUCACC
AAGCUCAAGGGCCCCUUGACCAUGAUGGCCAGCCACUACAAGCAGCACUGCCCUCCAACCCCGGAAACUUCCUGUGCAACCCAGAUUA
UCACCUUUGAAAGUUUCAAAGAGAACCUGAAGGACUUUCUGCUUGUCAUCCCCUUUGACUGCUGGGAGCCAGUCCAGGAGUGAUGA
As used herein, a “cytokine RNA mixture,” also sometimes referred to as “cytokine mRNA mixture,” “mRNA cytokine mixture,” or “RNA cytokine mixture” comprises RNA encoding IFNα, RNA encoding IL-15 sushi, RNA encoding IL-12sc, and RNA encoding GM-CSF, as described herein.
“PD-1” may also be referred to as “programmed cell death 1” or “programmed cell death-1.” “PD-L1” may also be referred to as “programmed cell death 1 ligand,” “programmed cell death-1 ligand 1,” or “programmed cell death-ligand 1.”
As used herein, an “advanced stage solid tumor cancer,” sometimes referred to herein as “advanced solid tumor,” or “advanced solid tumor cancer,” comprises a solid tumor cancer whose stage is identified as stage III, subsets of stage III, stage IV, or subsets of stage IV, assessed by a known system, e.g., the tumor, node, and metastasis (TNM) staging system developed by the American Joint Committee on Cancer (AJCC) (see AJCC Cancer Staging Manual, 8th Edition). In some embodiments, the TNM staging system is used for solid tumor cancers other than melanoma. In some embodiments, the cancer is melanoma or advanced melanoma, which comprises stage IIIB, stage IIIC, or stage V as assessed by the AJCC melanoma staging (edition 8, 2018). Non-limiting descriptions relating to AJCC melanoma staging are provided in Gershenwald J E, Scolyer R A, Hess K R, et al. Melanoma of the skin. In: Amin M B, ed. AJCC Cancer Staging Manual. 8th ed. Chicago, Ill.: AJCC-Springer; 2017:563-585, the entire contents of which are incorporated herein by reference. In some embodiments, the cancer is cutaneous squamous cell carcinoma (CSCC), or squamous cell carcinoma of the head and neck (HNSCC), both of which may be advanced. Similar staging systems exists for all major cancers and are generally based on the clinical and/or pathological details of the tumor and how these factors have been shown to impact survival.
“Tumor” may also be referred to herein as “neoplasm”. For instance, the terms “solid tumor” and “solid neoplasm” are interchangeable.
An “unresectable” (e.g., advanced-stage unresectable) cancer typically cannot be removed with surgery.
RECIST (Response Evaluation Criteria for Solid Tumours (also Tumors)) provides a methodology to evaluate the activity and efficacy of cancer therapeutics in solid tumors. RECIST guidelines were created by the RECIST Working Group comprising representatives from the European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States and Canadian Cancer Trials Group, as well as several pharmaceutical companies, and published in Eisenhauer E A, Therasse P, Bogaerts J et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1) Eur J Cancer. 45 (2009) 228-247, the entire contents of which are incorporated herein by reference. Section 4.3.1 of the guidelines (page 232-233 of Eisenhauer) provides the following regarding evaluation of target lesions:
While some non-target lesions may actually be measurable, they need not be measured and instead should be assessed only qualitatively at the time points specified in the protocol.
A subject having “innate” or “primary” resistance to an anti-PD-1 or anti-PD-L1 therapy, does not initially respond to anti-PD-1 or anti-PD-L1 therapy. A subject having innate or primary resistance never demonstrated a clinical response to PD-1/PD-L1 blockade. See, e.g., Sharma et al. (2017) Cell 168:707-723 at 709; see also, Hugo et al. (2016) Cell 165 (1) 35-44; see also, Nowicki et al. (2018) Cancer J. 24(1): 47-53, the entire contents of which are incorporated herein by reference. In some embodiments, a subject with innate resistance to an anti-PD-1 or anti-PD-L1 therapy is characterized after treatment with anti-PD-1 or anti-PD-L1 therapy (any length of time) as having Progressive Disease or Stable Disease according to RECIST criteria (version 1.1). In some embodiments, a subject with innate resistance to an anti-PD-1 or anti-PD-L1 therapy is characterized after treatment with anti-PD-1 or anti-PD-L1 therapy (any length of time) as having non-CR/Non-PD for non-target lesions comprising viable cancer cells. In some embodiments, a subject with innate resistance to an anti-PD-1 therapy is characterized after treatment with anti-PD-1 therapy (any length of time) as having Progressive Disease according to RECIST criteria (version 1.1). In some embodiments, a subject with innate resistance to an anti-PD-L1 therapy is characterized after treatment with anti-PD-L1 therapy (any length of time) as having Progressive Disease according to RECIST criteria (version 1.1). In some embodiments, a subject with innate resistance to an anti-PD-1 therapy is characterized after treatment with anti-PD-1 therapy (any length of time) as having Stable Disease according to RECIST criteria (version 1.1). In some embodiments, a subject with innate resistance to an anti-PD-L1 therapy is characterized after treatment with anti-PD-L1 therapy (any length of time) as having Stable Disease according to RECIST criteria (version 1.1). In some embodiments, a subject with innate resistance to an anti-PD-1 or anti-PD-L1 therapy is characterized after treatment with anti-PD-1 or anti-PD-L1 therapy (any length of time) as having at least a 20% increase in the longest diameter of a solid tumor and/or the appearance of one or more new solid tumors. In some embodiments, a subject with innate resistance to an anti-PD-1 is characterized after treatment with anti-PD-1 therapy (any length of time) as having at least a 20% increase in the longest diameter of solid tumors and/or the appearance of one or more new solid tumors. In some embodiments, a subject with innate resistance to an anti-PD-L1 therapy is characterized after treatment with anti-PD-L1 therapy (any length of time) as having at least a 20% increase in the longest diameter of solid tumors and/or the appearance of one or more new solid tumors. In some embodiments, the increase in the longest diameter is an increase of at least 5 mm. In some embodiments, the length of time is about 6 weeks, about 8 weeks, or at least 6 or 8 weeks. In some embodiments, the length of time is 2, 3, 6, 12, or more months. In some embodiments, the solid tumor is a primary tumor. In some embodiments, the solid tumor is an injectable tumor. In some embodiments, the solid tumor has been injected with the cytokine mRNA mixture. In some embodiments, the solid tumor has been selected for injection with the cytokine mRNA mixture. In some embodiments, the solid tumor is a subcutaneous lesion cm in longest diameter. In some embodiments, the solid tumor is within a group of multiple injectable merging lesions that are confluent. In some embodiments, the solid tumor is within a group of multiple injectable merging lesions that are confluent and have the longest diameter (sum of diameters of all involved target lesions) of cm. In some embodiments, the solid tumor is not bleeding or weeping. In some embodiments, the longest diameter of the solid tumor is at least 10 mm (e.g., as measured by Computed Tomography (CT) scan or caliper). In some embodiments, the solid tumor is in the chest of a subject and longest diameter of the solid tumor is at least 20 mm (e.g., as measured by chest X-ray). In some embodiments, the solid tumor is in a lymph node. In some embodiments, the lymph node is at least 15 mm in short axis (e.g., when assessed by CT scan). In some embodiments, the solid tumor is a lymphoma. In some embodiments, a subject with innate resistance to an anti-PD-1 or anti-PD-L1 therapy is characterized after treatment with anti-PD-1 or anti-PD-L1 therapy (any length of time) as having no response or stable disease according to the Lugano Classification. The version of the Lugano Classification referred to herein is described in Cheson et al. 2014 J Clin Oncol. 32(27):3059-68, the entire content of which is incorporated herein by reference. In some embodiments, a subject with innate resistance to an anti-PD-1 or anti-PD-L1 therapy is characterized after treatment with anti-PD-1 or anti-PD-L1 therapy (any length of time) as having progressive disease according to the Lugano Classification. In some embodiments, a subject with innate resistance to an anti-PD-1 or anti-PD-L1 therapy is characterized after treatment with anti-PD-1 or anti-PD-L1 therapy (any length of time) as having a lymphoma tumor within a lymph node. In some embodiments, a subject with innate resistance to an anti-PD-1 or anti-PD-L1 therapy is characterized after treatment with anti-PD-1 or anti-PD-L1 therapy (any length of time) as having a lymphoma tumor within a lymph node, wherein the lymph node has (i) a longest diameter of greater than 1.5 cm, and (ii) an increase of at least 50% from the product of the perpendicular diameters (PPDs) nadir. In some embodiments, the increase in the longest diameter is an increase of at least 5 mm. In some embodiments, the length of time is about 6 weeks, about 8 weeks, or at least 6 or 8 weeks. In some embodiments, the length of time is 2, 3, 6, 12, or more months.
A subject having “acquired” or “adaptive” resistance to an anti-PD-1 or anti-PD-L1 therapy initially responds to therapy (e.g., any level of response), but after a period of time relapses and progresses. In some embodiments, response to therapy is assessed as per RECIST criteria (version 1.1). In some embodiments, acquired or adaptive resistance to an anti-PD-1 or anti-PD-L1 therapy is seen in subjects who eventually progresses while on therapy despite an initial Complete Response or Partial Response, all according to RECIST criteria (version 1.1). In some embodiments, acquired or adaptive resistance to an anti-PD-1 or anti-PD-L1 therapy is seen in subjects who are unresponsive to re-initiation of an anti-PD-1 or anti-PD-L1 therapy. See, Sharma et al. (2017) Cell 168:707-723 at 708; see also, Nowicki et al. (2018) Cancer J. 24(1): 47-53, the entire contents of which are incorporated herein by reference. In some embodiments, a subject with adaptive resistance to an anti-PD-1 therapy comprises a solid tumor whose volume (i) decreased for a period of time after anti-PD-1 therapy began; and then (ii) increased after the period of time despite continued anti-PD-1 therapy. In some embodiments, a subject with adaptive resistance to an anti-PD-L1 therapy comprises a solid tumor whose volume (i) decreased for a period of time after anti-PD-L1 therapy began; and then (ii) increased after the period of time despite continued anti-PD-L1 therapy. In some embodiments, the adaptive resistance is associated with an acquired underlying mechanism of resistance. In embodiments, the adaptive resistance is associated with a mutation or an epigenetic change. In some embodiments, the adaptive resistance is associated with a mutation in a B2M gene. In some embodiments, the period of time is from 6 to 12 months. In some embodiments, the period of time is from 6 to 18 months. In some embodiments, the period of time is from 6 to 36 months. In some embodiments, the period of time is from 3 to 9 months. In some embodiments, the period of time is from 3 to 24 months. In some embodiments, the period of time is from 12 to 24 months. In some embodiments, the period of time is at least about 3, about 4, about 5, about 6, about 7, about 8, about 9, about 10, about 11, about 12, about 13, about 14, about 15, about 16, about 17, about 18, about 19, about 20, about 21, about 22, about 23, or about 24 months. In some embodiments, the period of time is at least about 4 months. In some embodiments, the period of time is at least about 6 months. In some embodiments, the period of time is at least about 12 months. In some embodiments, the period of time is at least about 24 months. In some embodiments, the period of time is at least about 30 months. In some embodiments, the period of time is at least about 36 months. In some embodiments, a subject with adaptive resistance to an anti-PD-1 or anti-PD-L1 therapy was characterized at any point during treatment as having a Complete Response and thereafter (and during treatment) was characterized as having Progressive Disease according to RECIST criteria (version 1.1). In some embodiments, a subject with adaptive resistance to an anti-PD-1 or anti-PD-L1 therapy was characterized at any point during treatment as having a Partial Response and thereafter (and during treatment) was characterized as having a Progressive Disease or Stable Disease, all according to RECIST criteria (version 1.1). In some embodiments, a subject with adaptive resistance to an anti-PD-1 or anti-PD-L1 therapy was characterized at any point during treatment as having a Partial Response and thereafter (and during treatment) was characterized as having Progressive Disease according to RECIST criteria (version 1.1). In some embodiments, a subject with adaptive resistance to an anti-PD-1 or anti-PD-L1 therapy was characterized at any point during treatment as having a Partial Response and thereafter (and during treatment) was characterized as having Stable Disease according to RECIST criteria (version 1.1). In some embodiments, the longest diameter of solid tumors in the subject decreased by at least 30% after the anti-PD-1 or anti-PD-L1 therapy began and then increased. In some embodiments, the longest diameter of solid tumors in the subject decreased by at least 30% after the anti-PD-1 or anti-PD-L1 therapy began and then increased by at least 20%. In some embodiments, the longest diameter of solid tumors in the subject decreased by at least 30% after the anti-PD-1 or anti-PD-L1 therapy began and then one or more new solid tumors appeared. In some embodiments, a subject with adaptive resistance to an anti-PD-1 or anti-PD-L1 therapy was characterized at any point during treatment as having least a 30% decrease in the longest diameter of solid tumors and thereafter (and during treatment) was characterized as having at least a 20% increase in the longest diameter of a solid tumors and/or the appearance of one or more new solid tumors. In some embodiment, the increase in the longest diameter is an increase of at least 5 mm. In some embodiments, a subject with adaptive resistance to an anti-PD-1 or anti-PD-L1 therapy was characterized at any point during treatment as having a disappearance of a solid tumor (e.g., every solid tumor that was present if more than one solid tumor was present) and thereafter (and during treatment) was characterized as having the reappearance of the solid tumor (e.g., in the same location as a solid tumor that disappeared) and/or the appearance of one or more new solid tumors. In some embodiments, the solid tumor is a primary tumor. In some embodiments, the solid tumor is an injectable tumor. In some embodiments, the tumor has been injected with the cytokine mRNA mixture. In some embodiments, the tumor has been selected for injection with the cytokine mRNA mixture. In some embodiments, the solid tumor is a subcutaneous lesion cm in longest diameter. In some embodiments, the solid tumor is within a group of multiple injectable merging lesions that are confluent. In some embodiments, the solid tumor is within a group of multiple injectable merging lesions that are confluent and have the longest diameter (sum of diameters of all involved target lesions) of cm. In some embodiments, the solid tumor is not bleeding or weeping. In some embodiments, the longest diameter of the solid tumor is at least 10 mm (e.g., as measured by Computed Tomography (CT) scan or caliper). In some embodiments, the solid tumor is in the chest of a subject and longest diameter of the solid tumor is at least 20 mm (e.g., as measured by chest X-ray). In some embodiments, the solid tumor is in a lymph node. In some embodiments, the lymph node is at least 15 mm in short axis (e.g., when assessed by CT scan). In some embodiments, the solid tumor is a lymphoma. In some embodiments, a subject with adaptive resistance to an anti-PD-1 or anti-PD-L1 therapy was characterized at any point during treatment as having a complete response and thereafter (and during treatment) was characterized as having progressive disease according to the Lugano Classification. In some embodiments, a subject with adaptive resistance to an anti-PD-1 or anti-PD-L1 therapy was characterized at any point during treatment as having at least a 50% decrease in the sum of the product of the perpendicular diameters (PPDs) for multiple lesions (e.g. for 1, 2, 3, 4, 5, or 6 lymph node or extranodal sites) and thereafter (and during treatment) was characterized as having a lymphoma tumor within a lymph node, wherein the lymph node has (i) a longest diameter of greater than 1.5 cm, and (ii) an increase of at least 50% from the PPD nadir.
A “refractory” or “resistant” cancer is one that does not respond to a specified treatment. In some embodiments, refraction occurs from the very beginning of treatment. In some embodiments, refraction occurs during treatment. In some embodiments, a cancer is resistant before treatment begins. In some embodiments, a cancer is refractory or resistant to anti-PD-1 therapy (i.e., the cancer does not respond to the therapy). In some embodiments, a cancer is refractory or resistant to anti-PD-L1 therapy (i.e., the cancer does not respond to the therapy). In some embodiments, a subject has a cancer that is becoming refractory or resistant to a specified treatment (such as an anti-PD1 or anti-PD-L1 therapy), e.g., the subject has become less responsive to the treatment since first receiving it. In some embodiments, the subject has not received the treatment, but has a type of cancer that does not typically respond to the treatment.
A “superficial” (also sometimes referred to as “cutaneous”) lesion or metastasis is a lesion or metastasis that is within the skin or is at the surface of skin. In some embodiments, a superficial lesion or metastasis is within the cutis. In some embodiments, a superficial lesion or metastasis is within the dermis. In some embodiments, a superficial lesion or metastasis is within the epidermis.
A “subcutaneous” lesion or metastasis is under the skin. In some embodiments, a subcutaneous lesion or metastasis is with the subcutis.
In some embodiments, and in the context of a solid tumor cancer, a “tumor lesion” or “lesion” is a solid tumor, e.g., a primary solid tumor or a solid tumor that has arisen from a metastasis from another solid tumor.
The term “squamous cell” refers to any thin flat cells found, for example, in the surface of the skin, eyes, various internal organs, and the lining of hollow organs and ducts of some glands.
The term “cutaneous squamous cell carcinoma” (or “CSCC”) refers to all stages and all forms of cancer that begin in cells that form the epidermis (outer layer of the skin). The term “cutaneous squamous cell carcinoma” is used interchangeably with the term “squamous cell carcinoma” of the skin.
The term “squamous cell carcinoma of the head and neck” (or “head and neck squamous cell carcinoma” or “HNSCC” or “squamous cell carcinoma for the head and neck”) refers to all stages and all forms of cancer of the head and neck that begin in squamous cells. Squamous cell carcinoma of the head and neck includes (but is not limited to) cancers of the nasal cavity, sinuses, lips, mouth, salivary glands, throat, and larynx (voice box).
The term “melanoma” refers to all stages and all forms of cancer that begins in melanocytes. Melanoma typically begins in a mole (skin melanoma), but can also begin in other pigmented tissues, such as in the eye or in the intestines.
A “tumor-involved regional lymph node” or “tumor-involved node” refers to metastasis-containing regional lymph node. In some embodiments, a tumor-involved regional lymph node is a clinically occult tumor-involved regional lymph node. In some embodiments, a tumor-involved regional lymph node is a clinically detectable tumor-involved regional lymph node. A “clinically occult” tumor-involved regional lymph node describes microscopically identified regional node metastasis without clinical or radiographic evidence of regional node metastasis. In some embodiments, a clinically occult tumor-involved regional lymph node is detected by sentinel lymph node (SLN) biopsy and without clinical or radiographic evidence of regional node metastasis. In some embodiments, “clinically detectable” nodal metastasis describes patients with regional node metastasis identifiable by clinical, radiographic, or ultrasound examination and usually (but not necessarily) confirmed by biopsy.
“Non-nodal locoregional sites” refer to metastases that are a consequence of intralymphatic or angiotrophic tumor spread and include microsatellite, satellite, and in-transit metastases. “Satellite” metastases refer to clinically evident cutaneous and/or subcutaneous metastases occurring within 2 cm of a primary melanoma.
“Microsatellite” metastases refer to microscopic cutaneous and/or subcutaneous metastases found adjacent or deep to a primary melanoma on pathological examination of the primary site. In some embodiments, microsatellite metastases are completely discontinuous from a primary melanoma with unaffected stroma occupying the space between.
“In-transit” metastases refer to clinically evident cutaneous and/or subcutaneous metastases identified at a distance more than 2 cm from a primary melanoma in the region between the primary and the first echelon of regional lymph nodes. In some embodiments, satellite or in-transmit metastases may occur distal to a primary melanoma.
“Matted nodes” refer to two or more nodes adherent to one another through involvement by metastatic disease. In some embodiments, matted nodes are identified at the time a specimen is examined macroscopically in a pathology laboratory.
A “distant metastasis” refers to cancer that has spread from the primary tumor to a distant organ or a distant lymph node. In some embodiments, the distant metastasis is detectable in skin, subcutaneous tissue, muscle, or distant lymph nodes. In some embodiments, the distant metastasis is detectable in a lung. In some embodiments, the distant metastasis is detectable in central nerve system (CNS). In some embodiments, the distant metastasis is detectable in any other visceral site other than CNS, including the lungs, the heart, or an organ of the digestive, excretory, reproductive, or circulatory system. In some embodiments, a distant metastasis is in a tissue or organ that is not in direct contact (e.g., touching or directly connected to) the tissue or organ containing the primary tumor.
In some embodiments, a metastasis (e.g., a distant metastasis) is in (e.g., is detectable in) the liver.
“Extranodal extension” (ENE) refers to the extension of metastatic cells through the nodal capsule into the perinodal tissue during nodal metastasis. Cystic metastasis that stretches, but does not breach, the lymph node capsule may be classified as ENE-negative. In some embodiments, the ENE-positive includes large extranodal vessels. In some embodiments, the ENE-positive extends less than 2 mm from the node capsule. In some embodiments, the ENE-positive extends more than 2 mm from the lymph node capsule or is apparent to the naked eye at dissection.
“Deep invasion” refers to as thickness greater than 6 mm or invasion deeper than subcutaneous fat. In some embodiments, invasion is present in nerves greater than 0.1 mm, deeper than the dermis.
“Inhibit,” “inhibitory,” and the like refer to a complete or partial block of an interaction, or a reduction in a biological effect. For example, an anti-PD1 antibody that inhibits binding of PD-1 to PD-L1 may completely or partially block the interaction. Inhibiting suppression of T cell activation includes any amount of a reduction in suppression. Inhibiting tumor growth or metastasis includes reduction or complete cessation.
The term “effective amount” refers to an amount of an agent (such as a mixture of RNAs) that provides a desired biological, therapeutic, and/or prophylactic result. That result can be reduction, amelioration, palliation, lessening, delaying, prevention, and/or alleviation of one or more of the signs, symptoms, or causes of a disease (such as advanced stage solid tumor cancer). In some embodiments, an effective amount comprises an amount sufficient to cause a solid tumor/lesion to shrink. In some embodiments, an effective amount is an amount sufficient to decrease the growth rate of a solid tumor (such as to suppress tumor growth). In some embodiments, an effective amount is an amount sufficient to delay tumor development. In some embodiments, an effective amount is an amount sufficient to prevent or delay tumor recurrence. In some embodiments, an effective amount is an amount sufficient to increase a subject's immune response to a tumor, such that tumor growth and/or size and/or metastasis is reduced, delayed, ameliorated, and/or prevented. An effective amount can be administered in one or more administrations. In some embodiments, administration of an effective amount (e.g., of a composition comprising mRNAs) may: (i) reduce the number of cancer cells; (ii) reduce tumor size; (iii) inhibit, retard, slow to some extent and may stop cancer cell infiltration into peripheral organs; (iv) inhibit (e.g., slow to some extent and/or block or prevent) metastasis; (v) inhibit tumor growth; (vi) prevent or delay occurrence and/or recurrence of tumor; and/or (vii) relieve to some extent one or more of the symptoms associated with the cancer.
The term “co-administered” or “co-administration” or the like as used herein refers to administration of two or more agents concurrently, simultaneously, or essentially at the same time, either as part of a single formulation or as multiple formulations that are administered by the same or different routes. “Essentially at the same time” as used herein means within about 1 minute, 5 minutes, 10 minutes, 15 minutes, 30 minutes, 1 hour, 2 hours, or 6 hours period of each other.
In some embodiments, the RNA comprises a modified nucleobase in place of at least one (e.g., every) uridine. In some embodiments, the RNA comprises a Cap1 structure at the 5′ end of the RNA. In some embodiments, the RNA comprises a modified nucleobase in place of at least one (e.g., every) uridine and a Cap1 structure at the 5′ end of the RNA. In some embodiments, the 5′ UTR comprises SEQ ID NOs: 4 or 6. In some embodiments, the RNA has been processed to reduce double-stranded RNA (dsRNA), such as, for example, by purification on cellulose (as described in the Examples and as known in the art), or via high performance liquid chromatography (HPLC). The “Cap1” structure may be generated after in-vitro transcription by enzymatic capping or during in-vitro transcription (co-transcriptional capping).
In some embodiments, the building block cap for modified RNA is as follows, which is used when co-transcriptionally capping:
m27,3′-OGppp(m12′-O)ApG (also sometimes referred to as m27,3′OG(5′)ppp(5′)m2′-OApG), which has the following structure:
Below is an exemplary Cap1 RNA after co-transcriptional capping, which comprises RNA and m27,3′OG(5′)ppp(5′)m2′-OApG:
Below is another exemplary Cap1 RNA after enzymatic capping (no cap analog):
In some embodiments, the RNA is modified with “Cap0” structures generated during in-vitro transcription (co-transcriptional capping) using, in one embodiment, the cap analog anti-reverse cap (ARCA Cap (m27,3′OG(5′)ppp(5′)G)) with the structure:
Below is an exemplary Cap0 RNA comprising RNA and m27,3′OG(5′)ppp(5′)G:
In some embodiments, the “Cap0” structures are generated during in-vitro transcription (co-transcriptional capping) using the cap analog Beta-S-ARCA (m27,2′OG(5′)ppSp(5′)G) with the structure:
Below is an exemplary Cap0 RNA comprising Beta-S-ARCA (m27,2′OG(5′)ppSp(5′)G) and RNA.
The term “uracil,” as used herein, describes one of the nucleobases that can occur in the nucleic acid of RNA. The structure of uracil is:
The term “uridine,” as used herein, describes one of the nucleosides that can occur in RNA. The structure of uridine is:
UTP (uridine 5′-triphosphate) has the following structure:
Pseudo-UTP (pseudouridine 5′-triphosphate) has the following structure:
“Pseudouridine” is one example of a modified nucleoside that is an isomer of uridine, where the uracil is attached to the pentose ring via a carbon-carbon bond instead of a nitrogen-carbon glycosidic bond. Pseudouridine is described, for example, in Charette and Gray, Life; 49:341-351 (2000).
Another exemplary modified nucleoside is N1-methyl-pseudouridine (m1Ψ), which has the structure:
N1-methyl-pseudo-UTP has the following structure:
Another exemplary modified nucleoside is 5-methyl-uridine (m5U), which has the structure:
As used herein, the term “poly-A tail” or “poly-A sequence” refers to an uninterrupted or interrupted sequence of adenylate residues which is typically located at the 3′ end of an RNA molecule. Poly-A tails or poly-A sequences are known to those of skill in the art and may follow the 3′ UTR in the RNAs described herein. An uninterrupted poly-A tail is characterized by consecutive adenylate residues. In nature, an uninterrupted poly-A tail is typical. RNAs disclosed herein can have a poly-A tail attached to the free 3′ end of the RNA by a template-independent RNA polymerase after transcription or a poly-A tail encoded by DNA and transcribed by a template-dependent RNA polymerase.
It has been demonstrated that a poly-A tail of about 120 A nucleotides has a beneficial influence on the levels of RNA in transfected eukaryotic cells, as well as on the levels of protein that is translated from an open reading frame that is present upstream (5′) of the poly-A tail (Holtkamp et al., 2006, Blood, vol. 108, pp. 4009-4017).
The poly-A tail may be of any length. In some embodiments, a poly-A tail comprises, essentially consists of, or consists of at least 20, at least 30, at least 40, at least 80, or at least 100 and up to 500, up to 400, up to 300, up to 200, or up to 150 A nucleotides, and, in particular, about 120 A nucleotides. In this context, “essentially consists of” means that most nucleotides in the poly-A tail, typically at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 96%, at least 97%, at least 98%, or at least 99% by number of nucleotides in the poly-A tail are A nucleotides, but permits that remaining nucleotides are nucleotides other than A nucleotides, such as U nucleotides (uridylate), G nucleotides (guanylate), or C nucleotides (cytidylate). In this context, “consists of” means that all nucleotides in the poly-A tail, i.e., 100% by number of nucleotides in the poly-A tail, are A nucleotides. The term “A nucleotide” or “A” refers to adenylate.
In some embodiments, a poly-A tail is attached during RNA transcription, e.g., during preparation of in vitro transcribed RNA, based on a DNA template comprising repeated dT nucleotides (deoxythymidylate) in the strand complementary to the coding strand. The DNA sequence encoding a poly-A tail (coding strand) is referred to as poly(A) cassette.
In some embodiments, the poly(A) cassette present in the coding strand of DNA essentially consists of dA nucleotides, but is interrupted by a random sequence of the four nucleotides (dA, dC, dG, and dT). Such random sequence may be 5 to 50, 10 to 30, or 10 to 20 nucleotides in length. Such a cassette is disclosed in WO 2016/005324 A1, hereby incorporated by reference. Any poly(A) cassette disclosed in WO 2016/005324 A1 may be used in the present invention. A poly(A) cassette that essentially consists of dA nucleotides, but is interrupted by a random sequence having an equal distribution of the four nucleotides (dA, dC, dG, dT) and having a length of e.g. 5 to 50 nucleotides shows, on DNA level, constant propagation of plasmid DNA in E. coli and is still associated, on RNA level, with the beneficial properties with respect to supporting RNA stability and translational efficiency is encompassed. Consequently, in some embodiments, the poly-A tail contained in an RNA molecule described herein essentially consists of A nucleotides, but is interrupted by a random sequence of the four nucleotides (A, C, G, U). Such random sequence may be 5 to 50, 10 to 30, or 10 to 20 nucleotides in length.
In some embodiments, no nucleotides other than A nucleotides flank a poly-A tail at its 3′ end, i.e., the poly-A tail is not masked or followed at its 3′ end by a nucleotide other than A.
In some embodiments, a poly-A tail comprises the sequence:
which is also shown in Table 1.
In general, “RNA” and “mRNA” are used interchangeably, except where the context makes clear that one or the other is appropriate, such as where “mRNA” is appropriate to use to distinguish from other types of RNA (rRNA or tRNA) and where “RNA” is appropriate to refer to the structure of the transcription product prior to the 5′ capping to form a mRNA.
“IFNα” is used generically herein to describe any interferon alpha Type I cytokine, including IFNα2b and IFNα4.
The term “treatment,” as used herein, covers any administration or application of a therapeutic for disease in a subject, and includes inhibiting the disease, arresting its development, relieving one or more symptoms of the disease, curing the disease, or preventing reoccurrence of the disease. For example, treatment of a solid tumor may comprise alleviating symptoms of the solid tumor, decreasing the size of the solid tumor, eliminating the solid tumor, reducing further growth of the tumor, or reducing or eliminating recurrence of a solid tumor after treatment. Treatment may also be measured as a change in a biomarker of effectiveness or in an imaging or radiographic measure.
The term “monotherapy,” as used herein, means a therapy that uses one type of treatment, such as, e.g., RNA therapy alone, radiation therapy alone, or surgery alone, to treat a certain disease or condition (such as cancer). In drug therapy, monotherapy refers to the use of a single drug (which may include multiple active agents, such as, e.g., a mixture of RNAs) to treat a disease or condition. In some embodiments, the monotherapy is a therapy that is administered to treat cancer, without any other therapy that is used to treat the cancer. In some embodiments, a monotherapy for treating a cancer may optionally be combined with another treatment to ameliorate a symptom of the cancer but not treat the cancer per se (e.g., the treatment is not intended or expected to impact the growth or size of a solid tumor), but may not be combined with any other therapy directed against the cancer, such as, e.g., a chemotherapeutic agent or radiation therapy. In such embodiments, administering a mixture of RNAs as a monotherapy means administering the mixture of RNAs without, e.g., radiation therapy or any chemotherapeutic agent. However, in such embodiments, administering a mixture of RNAs as a monotherapy does not preclude administering concurrently or simultaneously with the mixture of RNAs, agents that are not directed against the cancer, such as, e.g., agents that reduce pain.
The term “prevention,” as used herein, means inhibiting or arresting development of cancer, including solid tumors, in a subject deemed to be cancer free.
“Metastasis” means the process by which cancer spreads from the place at which it first arose as a primary tumor to other locations in the body.
The term “intratumorally,” or “intratumoral” as used herein, means into the tumor. For example, intra-tumoral injection means injecting the therapeutic at any location that touches the tumor.
As used herein, “lymphoma” is a solid tumor cancer derived from lymphocytes. Lymphoma includes Hodgkin and Non-Hodgkin lymphoma. Lymphoma forms solid tumors/neoplasms within lymph nodes, and can also be found in non-lymph node tissues when metastasized.
The term “peri-tumorally,” or “peri-tumoral,” or “peritumoral,” or “peritumorally” as used herein, is an area that is about 2-mm wide and is adjacent to the invasive front of the tumor periphery. The peri-tumoral area comprises host tissue. See, for example,
“Administering” means providing a pharmaceutical agent or composition to a subject, and includes, but is not limited to, administering by a medical professional and self-administering.
The disclosure describes nucleic acid sequences and amino acid sequences having a certain degree of identity to a given nucleic acid sequence or amino acid sequence, respectively (a reference sequence).
“Sequence identity” between two nucleic acid sequences indicates the percentage of nucleotides that are identical between the sequences. “Sequence identity” between two amino acid sequences indicates the percentage of amino acids that are identical between the sequences.
The terms “% identical”, “% identity” or similar terms are intended to refer, in particular, to the percentage of nucleotides or amino acids which are identical in an optimal alignment between the sequences to be compared. Said percentage is purely statistical, and the differences between the two sequences may be but are not necessarily randomly distributed over the entire length of the sequences to be compared. Comparisons of two sequences are usually carried out by comparing the sequences, after optimal alignment, with respect to a segment or “window of comparison”, in order to identify local regions of corresponding sequences. The optimal alignment for a comparison may be carried out manually or with the aid of the local homology algorithm by Smith and Waterman, 1981, Ads App. Math. 2, 482, with the aid of the local homology algorithm by Neddleman and Wunsch, 1970, J. Mol. Biol. 48, 443, with the aid of the similarity search algorithm by Pearson and Lipman, 1988, Proc. Natl Acad. Sci. USA 88, 2444, or with the aid of computer programs using said algorithms (GAP, BESTFIT, FASTA, BLAST P, BLAST N and TFASTA in Wisconsin Genetics Software Package, Genetics Computer Group, 575 Science Drive, Madison, Wis.). In some embodiments, percent identity of two sequences is determined using the BLASTN or BLASTP algorithm, as available on the United States National Center for Biotechnology Information (NCBI) website (e.g., at blast.ncbi.nlm.nih.gov/Blast.cgi?PAGE_TYPE=BlastSearch&BLAST_SPEC=blast2seq&LINK_LOC=align2seq). In some embodiments, the algorithm parameters used for BLASTN algorithm on the NCBI website include: (i) Expect Threshold set to 10; (ii) Word Size set to 28; (iii) Max matches in a query range set to 0; (iv) Match/Mismatch Scores set to 1, −2; (v) Gap Costs set to Linear; and (vi) the filter for low complexity regions being used. In some embodiments, the algorithm parameters used for BLASTP algorithm on the NCBI website include: (i) Expect Threshold set to 10; (ii) Word Size set to 3; (iii) Max matches in a query range set to 0; (iv) Matrix set to BLOSUM62; (v) Gap Costs set to Existence: 11 Extension: 1; and (vi) conditional compositional score matrix adjustment.
Percentage identity is obtained by determining the number of identical positions at which the sequences to be compared correspond, dividing this number by the number of positions compared (e.g., the number of positions in the reference sequence) and multiplying this result by 100.
In some embodiments, the degree of identity is given for a region which is at least about 50%, at least about 60%, at least about 70%, at least about 80%, at least about 90% or about 100% of the entire length of the reference sequence. For example, if the reference nucleic acid sequence consists of 200 nucleotides, the degree of identity is given for at least about 100, at least about 120, at least about 140, at least about 160, at least about 180, or about 200 nucleotides, in some embodiments in continuous nucleotides. In some embodiments, the degree of identity is given for the entire length of the reference sequence.
Nucleic acid sequences or amino acid sequences having a particular degree of identity to a given nucleic acid sequence or amino acid sequence, respectively, may have at least one functional property of said given sequence, e.g., and in some instances, are functionally equivalent to said given sequence. One important property includes the ability to act as a cytokine, in particular when administered to a subject. In some embodiments, a nucleic acid sequence or amino acid sequence having a particular degree of identity to a given nucleic acid sequence or amino acid sequence is functionally equivalent to the given sequence.
The term “antibody” as used herein encompasses various antibody structures, including monoclonal antibodies, polyclonal antibodies, multispecific antibodies (for example, bispecific and trispecific antibodies), and antibody fragments so long as they exhibit the desired activity.
The term antibody includes, fragments that are capable of binding to an antigen, such as Fv, single-chain Fv (scFv), Fab, Fab′, di-scFv, sdAb (single domain antibody) and (Fab′)2 (including a chemically linked F(ab′)2). The term antibody also includes chimeric antibodies and humanized antibodies as long as they are suitable for human administration. Antibody fragments also include either orientation of single chain scFvs, tandem di-scFv, diabodies, tandem tri-sdcFv, minibodies, etc. Antibody fragments also include nanobodies (sdAb, an antibody having a single, monomeric domain, such as a pair of variable domains of heavy chains, without a light chain).
The term “monoclonal antibody” refers to an antibody of a substantially homogeneous population of antibodies, that is, the individual antibodies comprising the population are identical except for possible naturally-occurring mutations that may be present in minor amounts. Monoclonal antibodies are highly specific, being directed against a single antigenic site. Furthermore, in contrast to polyclonal antibody preparations, which typically include different antibodies directed against different determinants (epitopes), each monoclonal antibody is directed against a single determinant on the antigen. Thus, a sample of monoclonal antibodies can bind to the same epitope on the antigen. The modifier “monoclonal” indicates the character of the antibody as being obtained from a substantially homogeneous population of antibodies, and is not to be construed as requiring production of the antibody by any particular method. For example, the monoclonal antibodies may be made by the hybridoma method first described by Kohler and Milstein, 1975, Nature 256:495, or may be made by recombinant DNA methods such as described in U.S. Pat. No. 4,816,567. The monoclonal antibodies may also be isolated from phage libraries generated using the techniques described in McCafferty et al., 1990, Nature 348:552-554, for example.
The term “CDR” denotes a complementarity determining region as defined by at least one manner of identification to one of skill in the art. The various CDRs within an antibody can be designated by their appropriate number and chain type, including, without limitation as: a) CDR-L1, CDR-L2, CDR-L3, CDR-H1, CDR-H2, and CDR-H3; b) CDRL1, CDRL2, CDRL3, CDRH1, CDRH2, and CDRH3; c) LCDR-1, LCDR-2, LCDR-3, HCDR-1, HCDR-2, and HCDR-3; or d) LCDR1, LCDR2, LCDR3, HCDR1, HCDR2, and HCDR3; etc. The term “CDR” is used herein to also encompass HVR or a “hyper variable region”, including hypervariable loops (e.g., Chothia and Lesk, J. Mol. Biol. 196:901-917 (1987).)
The term “heavy chain variable region” as used herein refers to a region comprising at least three heavy chain CDRs. In some embodiments, the heavy chain variable region includes the three CDRs and at least FR2 and FR3. In some embodiments, the heavy chain variable region includes at least heavy chain HCDR1, framework (FR) 2, HCDR2, FR3, and HCDR3. In some embodiments, a heavy chain variable region also comprises at least a portion of an FR1 and/or at least a portion of an FR4.
The term “heavy chain constant region” as used herein refers to a region comprising at least three heavy chain constant domains, CH1, CH2, and CH3. Of course, non-function-altering deletions and alterations within the domains are encompassed within the scope of the term “heavy chain constant region,” unless designated otherwise. Nonlimiting exemplary heavy chain constant regions include γ, δ, and α. Nonlimiting exemplary heavy chain constant regions also include ε and μ. Each heavy constant region corresponds to an antibody isotype. For example, an antibody comprising a γ constant region is an IgG antibody, an antibody comprising a δ constant region is an IgD antibody, and an antibody comprising an α constant region is an IgA antibody. Further, an antibody comprising a μ constant region is an IgM antibody, and an antibody comprising an ε constant region is an IgE antibody. Certain isotypes can be further subdivided into subclasses. For example, IgG antibodies include, but are not limited to, IgG1 (comprising a γ1 constant region), IgG2 (comprising a γ2 constant region), IgG3 (comprising a γ3 constant region), and IgG4 (comprising a γ4 constant region) antibodies; IgA antibodies include, but are not limited to, IgA1 (comprising an α1 constant region) and IgA2 (comprising an α2 constant region) antibodies; and IgM antibodies include, but are not limited to, IgM1 and IgM2.
The term “heavy chain” as used herein refers to a polypeptide comprising at least a heavy chain variable region, with or without a leader sequence. In some embodiments, a heavy chain comprises at least a portion of a heavy chain constant region. The term “full-length heavy chain” as used herein refers to a polypeptide comprising a heavy chain variable region and a heavy chain constant region, with or without a leader sequence.
The term “light chain variable region” as used herein refers to a region comprising at least three light chain CDRs. In some embodiments, the light chain variable region includes the three CDRs and at least FR2 and FR3. In some embodiments, the light chain variable region includes at least light chain LCDR1, framework (FR) 2, LCDR2, FR3, and LCDR3. For example, a light chain variable region may comprise light chain CDR1, framework (FR) 2, CDR2, FR3, and CDR3. In some embodiments, a light chain variable region also comprises at least a portion of an FR1 and/or at least a portion of an FR4.
The term “light chain constant region” as used herein refers to a region comprising a light chain constant domain, CL. Nonlimiting exemplary light chain constant regions include λ and κ. Of course, non-function-altering deletions and alterations within the domains are encompassed within the scope of the term “light chain constant region,” unless designated otherwise.
The term “light chain” as used herein refers to a polypeptide comprising at least a light chain variable region, with or without a leader sequence. In some embodiments, a light chain comprises at least a portion of a light chain constant region. The term “full-length light chain” as used herein refers to a polypeptide comprising a light chain variable region and a light chain constant region, with or without a leader sequence.
As used herein, the term “epitope” refers to a site on a target molecule to which an antibody binds. Epitopes often include a chemically active surface grouping of molecules such as amino acids, polypeptides or sugar side chains and have specific three-dimensional structural characteristics as well as specific charge characteristics.
Unless specifically noted in the above specification, embodiments in the specification that recite “comprising” various components are also contemplated as “consisting of” or “consisting essentially of” the recited components; embodiments in the specification that recite “consisting of” various components are also contemplated as “comprising” or “consisting essentially of” the recited components; and embodiments in the specification that recite “consisting essentially of” various components are also contemplated as “consisting of” or “comprising” the recited components (this interchangeability does not apply to the use of these terms in the claims). As used in a clause of a claim, the transitional term “comprising”, which is synonymous with “including,” “containing,” or “characterized by,” is inclusive or open-ended and does not exclude additional, unrecited elements or method steps. As used in a clause of a claim, the transitional phrase “consisting of” excludes any element, step, or component not specified in the claim, and the transitional phrase “consisting essentially of” limits the scope of the claim term to the recited components and those that do not materially affect the basic and novel characteristics of the claimed term, as understood from the specification.
In some embodiments, methods for treating advanced-stage solid tumor cancers are encompassed comprising administering to a subject having an advanced-stage solid tumor cancer RNA encoding an IL-12sc protein, RNA encoding an IL-15 sushi protein, RNA encoding an IFNα protein, and RNA encoding a GM-CSF protein in combination with an anti-PD-1 antibody. Details of the administered RNA follow.
In some embodiments, administering RNAs comprises administering RNA encoding IFNα, RNA encoding IL-15 sushi, RNA encoding IL-12sc, and RNA encoding GM-CSF, optionally modified to have a modified nucleobase in place of each uridine and a Cap1 structure at the 5′ end of the RNA.
In some embodiments, administering RNAs comprises administering RNA encoding IL-12sc and further administering an RNA encoding IFNα, IL-15 sushi, and GM-CSF.
In some embodiments, administering RNAs comprises administering RNA encoding IFNα and further administering an RNA encoding IL-12sc, IL-15 sushi, and GM-CSF.
In some embodiments, administering RNAs comprises administering RNA encoding IL-15 sushi and further administering an RNA encoding IL-12sc, IFNα, and GM-CSF.
In some embodiments administering RNAs comprises administering RNA encoding GM-CSF sushi and further administering an RNA encoding IL-12sc, IFNα, and IL-15 sushi.
In some embodiments, the IFNα protein in the cytokine RNA mixture is an IFNα2b protein, and the method comprises administering RNA encoding an IFNα2b protein.
In some embodiments, (i) the RNA encoding an IL-12sc protein comprises the nucleotide sequence of SEQ ID NO: 17 or 18, or a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the nucleotide sequence of SEQ ID NO: 17 or 18 and/or (ii) the IL-12sc protein comprises the amino acid sequence of SEQ ID NO: 14, or an amino acid sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the amino acid sequence of SEQ ID NO: 14.
In some embodiments, (i) the RNA encoding an IL-15 sushi protein comprises the nucleotide sequence of SEQ ID NO: 26, or a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the nucleotide sequence of SEQ ID NO: 26 and/or (ii) the IL-15 sushi protein comprises the amino acid sequence of SEQ ID NO: 24, or an amino acid sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the amino acid sequence of SEQ ID NO: 24.
In some embodiments, (i) the RNA encoding an IFNα protein comprises the nucleotide sequence of SEQ ID NO: 22 or 23, or a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the nucleotide sequence of SEQ ID NO: 22 or 23 and/or (ii) the IFNα protein comprises the amino acid sequence of SEQ ID NO: 19, or an amino acid sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the amino acid sequence of SEQ ID NO: 19.
In some embodiments, (i) the RNA encoding a GM-CSF protein comprises the nucleotide sequence of SEQ ID NO: 29, or a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the nucleotide sequence of SEQ ID NO: 29 and/or (ii) the GM-CSF protein comprises the amino acid sequence of SEQ ID NO: 27, or an amino acid sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the amino acid sequence of SEQ ID NO: 27.
A. Interleukin-12 Single-Chain (IL-12sc)
In some embodiments, an RNA that encodes interleukin-12 single-chain (IL-12sc) is provided. In some embodiments, the interleukin-12 single-chain (IL-12sc) RNA is encoded by a DNA sequence encoding interleukin-12 single-chain (IL-12sc) (e.g., SEQ ID NO: 14), which comprises IL-12 p40 (sometimes referred to as IL-12B; encoded by nucleotides 1-984 of SEQ ID NO: 15), a linker, such as a GS linker, and IL-12 p35 (sometimes referred to as IL-12A; encoded by nucleotides 1027-1623 of SEQ ID NO: 15). In some embodiments, the IL-12p40, linker, and IL-12p35 are consecutive with no intervening nucleotides. An exemplary DNA sequence encoding IL-12sc is provided in SEQ ID NO: 15. In some embodiments, the interleukin-12 single-chain (IL-12sc) RNA is provided at SEQ ID NO: 17 or 18, both of which encode the protein of SEQ ID NO: 14. The RNA sequence of IL-12 p40 is shown at nucleotides 1-984 of SEQ ID NO: 17 or 18 and the RNA sequence of IL-12 p35 is shown at nucleotides 1027-1623 of SEQ ID NO: 17 or 18.
In some embodiments, the IL-12sc RNA is encoded by a codon-optimized DNA sequence encoding IL-12sc. In some embodiments, the IL-12sc RNA is encoded by a codon-optimized DNA sequence encoding IL-12 p40. In some embodiments, the IL-12sc RNA is encoded by a codon-optimized DNA sequence encoding IL-12 p35. In some embodiments, the codon-optimized DNA sequence comprises or consists of SEQ ID NO: 16. In some embodiments, the DNA sequence comprises a codon-optimized DNA sequence with 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% identity to SEQ ID NO: 16. In some embodiments, the codon-optimized DNA sequence encoding IL-12 p40 comprises the nucleotides encoding the IL-12sc-p40 (nucleotides 1-984 of SEQ ID NO: 16). In some embodiments, the codon-optimized DNA sequence encoding IL-12 p35 comprises the nucleotides encoding the IL-12sc-p35 (nucleotides 1027-1623 of SEQ ID NO: 16). In some embodiments, the codon-optimized DNA sequence encoding IL-12sc comprises the nucleotides encoding the IL-12sc-p40 (nucleotides 1-984 of SEQ ID NO: 16) and -p35 (nucleotides 1027-1623 of SEQ ID NO: 16) portions of SEQ ID NO: 16 and further comprises nucleotides between the p40 and p35 portions (e.g., nucleotides 985-1026 of SEQ ID NO: 16) encoding a linker polypeptide connecting the p40 and p35 portions. Any linker known to those of skill in the art may be used. The p40 portion may be 5′ or 3′ to the p35 portion.
In some embodiments, the IL-12sc RNA comprises an RNA sequence that is, for example, transcribed from a DNA sequence encoding IL-12sc. The RNA may also be recombinantly produced. In some embodiments, the RNA sequence is transcribed from a nucleotide sequence comprising SEQ ID NOs: 15 or 16. In some embodiments, the RNA sequence comprises or consists of SEQ ID NOs: 17 or 18. In some embodiments, the RNA sequence comprises or consists of an RNA sequence with 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% identity to SEQ ID NOs: 17 or 18. In some embodiments, the RNA sequence comprises the nucleotides encoding the IL-12sc-p40 (nucleotides 1-984 of SEQ ID NOs: 17 or 18) and -p35 (nucleotides 1027-1623 of SEQ ID NOs: 17 or 18) portions of SEQ ID NOs: 17 or 18. In some embodiments, the codon-optimized RNA sequence encoding IL-12sc comprises the nucleotides encoding the IL-12sc-p40 (nucleotides 1-984 of SEQ ID NO: 18) and -p35 (nucleotides 1027-1623 of SEQ ID NO: 18) portions of SEQ ID NO: 18 and further comprises nucleotides between the p40 and p35 portions encoding a linker polypeptide connecting the p40 and p35 portions. Any linker known to those of skill in the art may be used.
In some embodiments, one or more uridine in the IL-12sc RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U). In some embodiments, the RNA comprises a modified nucleoside in place of each uridine. In some embodiments, the modified nucleoside is N1-methyl-pseudouridine (m1ψ).
In some embodiments, the IL-12sc RNA comprises an altered nucleotide at the 5′ end. In some embodiments, the RNA comprises a 5′ cap. Any 5′ cap known in the art may be used. In some embodiments, the 5′ cap comprises a 5′ to 5′ triphosphate linkage. In some embodiments, the 5′ cap comprises a 5′ to 5′ triphosphate linkage including thiophosphate modification. In some embodiments, the 5′ cap comprises a 2′-O or 3′-O-ribose-methylated nucleotide. In some embodiments, the 5′ cap comprises a modified guanosine nucleotide or modified adenosine nucleotide. In some embodiments, the 5′ cap comprises 7-methylguanylate. In some embodiments, the 5′ cap is Cap0 or Cap1. Exemplary cap structures include m7G(5′)ppp(5′)G, m7,2′O-mG(5′)ppsp(5′)G, m7G(5′)ppp(5′)2′O-mG, and m7,3′O-mG(5′)ppp(5′)2′O-mA.
In some embodiments, the IL-12sc RNA comprises a 5′ untranslated region (UTR). In some embodiments, the 5′ UTR is upstream of the initiation codon. In some embodiments, the 5′ UTR regulates translation of the RNA. In some embodiments, the 5′ UTR is a stabilizing sequence. In some embodiments, the 5′ UTR increases the half-life of RNA. Any 5′ UTR known in the art may be used. In some embodiments, the 5′ UTR RNA sequence is transcribed from SEQ ID NOs: 3 or 5. In some embodiments, the 5′ UTR RNA sequence comprises or consists of SEQ ID NOs: 4 or 6. In some embodiments, the 5′ UTR RNA sequence is at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% identical to SEQ ID NOs: 4 or 6.
In some embodiments, the IL-12sc RNA comprises a 3′ UTR. In some embodiments, the 3′ UTR follows the translation termination codon. In some embodiments, the 3′ UTR regulates polyadenylation, translation efficiency, localization, or stability of the RNA. In some embodiments, the 3′ UTR RNA sequence is transcribed from SEQ ID NO: 7. In some embodiments, the 3′ UTR RNA sequence comprises or consists of SEQ ID NO: 8. In some embodiments, the 3′ UTR RNA sequence is at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% identical to SEQ ID NO: 8.
In some embodiments, the IL-12sc RNA comprises both a 5′ UTR and a 3′ UTR. In some embodiments, the IL-12sc RNA comprises only a 5′ UTR. In some embodiments, the IL-12sc RNA comprises only a 3′ UTR.
In some embodiments, the IL-12sc RNA comprises a poly-A tail. In some embodiments, the RNA comprises a poly-A tail of at least about 25, at least about 30, at least about 50 nucleotides, at least about 70 nucleotides, or at least about 100 nucleotides. In some embodiments, the poly-A tail comprises 200 or more nucleotides. In some embodiments, the poly-A tail comprises or consists of SEQ ID NO: 30.
In some embodiments, the RNA comprises a 5′ cap, a 5′ UTR, a nucleic acid encoding IL-12sc, a 3′ UTR, and a poly-A tail, in that order.
In some embodiments, the IL-12sc RNA is encoded by a DNA sequence comprising or consisting of a nucleic acid sequence that is at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 15 or 16 and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 3 or 5.
In some embodiments, the IL-12sc RNA comprises an RNA sequence that is, for example, transcribed from a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 15 or 16 and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 3 or 5. The RNA may also be recombinantly produced. In some embodiments, one or more uridine in the IL-12sc RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U). In some embodiments, the RNA comprises a modified nucleoside in place of each uridine. In some embodiments, the modified nucleoside is N1-methyl-pseudouridine (m1ψ).
In some embodiments, the IL-12sc RNA is encoded by a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 15 or 16 and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 7.
In some embodiments, the IL-12sc RNA comprises an RNA sequence that is, for example, transcribed from a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 15 or 16 and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 7. The RNA may also be recombinantly produced. In some embodiments, one or more uridine in the IL-12sc RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U). In some embodiments, the RNA comprises a modified nucleoside in place of each uridine. In some embodiments, the modified nucleoside is N1-methyl-pseudouridine (m1ψ).
In some embodiments, the IL-12sc RNA is encoded by a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 15 or 16; at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 3 or 5; and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 7.
In some embodiments, the IL-12sc RNA comprises an RNA sequence that is, for example, transcribed from a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 15 or 16; at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 3 or 5; and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 7. The RNA may also be recombinantly produced. In some embodiments, one or more uridine in the IL-12sc RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U). In some embodiments, the RNA comprises a modified nucleoside in place of each uridine. In some embodiments, the modified nucleoside is N1-methyl-pseudouridine (m1ψ).
In some embodiments, the IL-12sc RNA comprises an RNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 17 or 18; at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 4 or 6; and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 8. In some embodiments, one or more uridine in the IL-12sc RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U).
B. Interferon Alpha (IFNα)
In some embodiments, the interferon alpha (IFNα) RNA is encoded by a DNA sequence encoding interferon alpha (IFNα) (e.g., SEQ ID NO: 19). An exemplary DNA sequence encoding this IFNα is provided in SEQ ID NO: 20.
In some embodiments, the IFNα RNA is encoded by a codon-optimized DNA sequence encoding IFNα. In some embodiments, the codon-optimized DNA sequence comprises or consists of the nucleotides of SEQ ID NO: 21. In some embodiments, the DNA sequence comprises or consists of a codon-optimized DNA sequence with 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% identity to SEQ ID NO: 21.
In some embodiments, the IFNα RNA comprises an RNA sequence that is, for example, transcribed from a DNA sequence encoding IFNα. The RNA may also be recombinantly produced. In some embodiments, the RNA sequence is transcribed from a nucleotide sequence comprising SEQ ID NOs: 20 or 21. In some embodiments, the RNA sequence comprises or consists of SEQ ID NOs: 22 or 23. In some embodiments, the RNA sequence comprises or consists of an RNA sequence with 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% identity to SEQ ID NOs: 22 or 23.
In some embodiments, one or more uridine in the IFNα RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U). In some embodiments, each uridine in the RNA is modified. In some embodiments, each uridine in the RNA is modified with N1-methyl-pseudouridine (m1ψ).
In some embodiments, the IFNα RNA comprises an altered nucleotide at the 5′ end. In some embodiments, the IFNα RNA comprises a 5′ cap. Any 5′ cap known in the art may be used. In some embodiments, the 5′ cap comprises a 5′ to 5′ triphosphate linkage. In some embodiments, the 5′ cap comprises a 5′ to 5′ triphosphate linkage including thiophosphate modification. In some embodiments, the 5′ cap comprises a 2′-O or 3′-O-ribose-methylated nucleotide. In some embodiments, the 5′ cap comprises a modified guanosine nucleotide or modified adenosine nucleotide. In some embodiments, the 5′ cap comprises 7-methylguanylate. In some embodiments, the 5′ cap is Cap0 or Cap1. Exemplary cap structures include m7G(5′)ppp(5′)G, m7,2′ O-mG(5′)ppsp(5′)G, m7G(5′)ppp(5′)2′O-mG and m7,3′O-mG(5′)ppp(5′)2′O-mA.
In some embodiments, the IFNα RNA comprises a 5′ untranslated region (UTR). In some embodiments, the 5′ UTR is upstream of the initiation codon. In some embodiments, the 5′ UTR regulates translation of the RNA. In some embodiments, the 5′ UTR is a stabilizing sequence. In some embodiments, the 5′ UTR increases the half-life of RNA. Any 5′ UTR known in the art may be used. In some embodiments, the 5′ UTR RNA sequence is transcribed from a nucleotide sequence comprising SEQ ID NOs: 3 or 5. In some embodiments, the 5′ UTR RNA sequence comprises or consists of SEQ ID NOs: 4 or 6. In some embodiments, the 5′ UTR RNA sequence is at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% identical to SEQ ID NOs: 4 or 6.
In some embodiments, the IFNα RNA comprises a 3′ UTR. In some embodiments, the 3′ UTR follows the translation termination codon. In some embodiments, the 3′ UTR regulates polyadenylation, translation efficiency, localization, or stability of the RNA. In some embodiments, the 3′ UTR RNA sequence is transcribed from a nucleotide sequence comprising SEQ ID NO: 7. In some embodiments, the 3′ UTR RNA sequence comprises or consists of SEQ ID NO: 8. In some embodiments, the 3′ UTR RNA sequence is at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% identical to SEQ ID NO: 8.
In some embodiments, the IFNα RNA comprises both a 5′ UTR and a 3′ UTR. In some embodiments, the composition comprises only a 5′ UTR. In some embodiments, the composition comprises only a 3′ UTR.
In some embodiments, the IFNα RNA comprises a poly-A tail. In some embodiments, the IFNα RNA comprises a poly-A tail of at least about 25, at least about 30, at least about 50 nucleotides, at least about 70 nucleotides, or at least about 100 nucleotides. In some embodiments, the poly-A tail comprises 200 or more nucleotides. In some embodiments, the poly-A tail comprises or consists of SEQ ID NO: 30.
In some embodiments, the RNA comprises a 5′ cap, a 5′ UTR, a nucleic acid encoding IFNα, a 3′ UTR, and a poly-A tail, in that order.
In some embodiments, the IFNα RNA is encoded by a DNA sequence comprising or consisting of a nucleic acid sequence that is at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 20 or 21 and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 3 or 5.
In some embodiments, the IFNα RNA comprises an RNA sequence that is, for example, transcribed from a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 20 or 21 and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 3 or 5. The RNA may also be recombinantly produced. In some embodiments, one or more uridine in the IFNα RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U). In some embodiments, the RNA comprises a modified nucleoside in place of each uridine. In some embodiments, the modified nucleoside is N1-methyl-pseudouridine (m1ψ).
In some embodiments, the IFNα RNA is encoded by a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 20 or 21 and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 7.
In some embodiments, the IFNα RNA comprises an RNA sequence that is, for example, transcribed from a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 20 or 21 and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 7. In some embodiments, one or more uridine in the IFNα RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U). In some embodiments, the RNA comprises a modified nucleoside in place of each uridine. In some embodiments, the modified nucleoside is N1-methyl-pseudouridine (m1ψ).
In some embodiments, the IFNα RNA is encoded by a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 20 or 21; at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 3 or 5; and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 7.
In some embodiments, the IFNα RNA comprises an RNA sequence that is, for example, transcribed from a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 20 or 21; at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 3 or 5; and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 7. The RNA may also be recombinantly produced. In some embodiments, one or more uridine in the IFNα RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U). In some embodiments, the RNA comprises a modified nucleoside in place of each uridine. In some embodiments, the modified nucleoside is N1-methyl-pseudouridine (m1ψ). In some embodiments, the composition comprises an RNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 22 or 23; at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 4 or 6; and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 8. In some embodiments, one or more uridine in the IFNα RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U).
C. Interleukin 15 (IL-15) Sushi
In some embodiments, an RNA that encodes an interleukin-15 (IL-15) sushi is administered. As used herein, the term “IL-15 sushi” describes a construct comprising the soluble interleukin 15 (IL-15) receptor alpha sushi domain and mature interleukin alpha (IL-15) as a fusion protein. In some embodiments, the IL-15 sushi RNA is encoded by a DNA sequence encoding IL-15 sushi (SEQ ID NO: 24), which comprises the soluble IL-15 receptor alpha chain (sushi) followed by a glycine-serine (GS) linker followed by the mature sequence of IL-15. The DNA sequence encoding this IL-15 sushi is provided in SEQ ID NO: 25.
In some embodiments, the IL-15 sushi RNA is an RNA sequence that is, for example, transcribed from a DNA sequence encoding IL-15 sushi. The RNA may also be recombinantly produced. In some embodiments, the RNA sequence is transcribed from a nucleotide sequence comprising SEQ ID NO: 25. In some embodiments, the nucleotides encoding the linker may be completely absent or replaced in part or in whole with any nucleotides encoding a suitable linker. In some embodiments, the RNA sequence comprises or consists of SEQ ID NO: 26. In some embodiments, the RNA sequence comprises an RNA sequence with 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% identity to SEQ ID NO: 26. In some embodiments, the DNA or RNA sequence encoding IL-15 sushi comprises the nucleotides encoding the sushi domain of IL-15 receptor alpha (e.g., nucleotide 1-321 of SEQ ID NOs: 25 or 26) and mature IL-15 (e.g., nucleotide 382-729 of SEQ ID NO: 25 or 26). In some embodiments, the DNA or RNA sequence encoding IL-15 sushi comprises the nucleotides encoding the sushi domain of IL-15 receptor alpha (e.g., nucleotide 1-321 of SEQ ID NOs: 25 or 26) and mature IL-15 (e.g., nucleotide 382-729 of SEQ ID NOs: 25 or 26) and further comprises nucleotides between these portions encoding a linker polypeptide connecting the portions. In some embodiments, the linker comprises nucleotides 322-381 of SEQ ID Nos: 25 or 26. Any linker known to those of skill in the art may be used.
In some embodiments, one or more uridine in the IL-15 sushi RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U). In some embodiments, the RNA comprises a modified nucleoside in place of each uridine. In some embodiments, the modified nucleoside is N1-methyl-pseudouridine (m1ψ).
In some embodiments, the IL-15 sushi RNA comprises an altered nucleotide at the 5′ end. In some embodiments, the IL-15 sushi RNA comprises a 5′ cap. Any 5′ cap known in the art may be used. In some embodiments, the 5′ cap comprises a 5′ to 5′ triphosphate linkage. In some embodiments, the 5′ cap comprises a 5′ to 5′ triphosphate linkage including thiophosphate modification. In some embodiments, the 5′ cap comprises a 2′-O or 3′-O-ribose-methylated nucleotide. In some embodiments, the 5′ cap comprises a modified guanosine nucleotide or modified adenosine nucleotide. In some embodiments, the 5′ cap comprises 7-methylguanylate. In some embodiments, the 5′ cap is Cap0 or Cap1. Exemplary cap structures include m7G(5′)ppp(5′)G, m7,2′ O-mG(5′)ppsp(5′)G, m7G(5′)ppp(5′)2′O-mG and m7,3′O-mG(5′)ppp(5′)2′O-mA.
In some embodiments, the IL-15 sushi RNA comprises a 5′ untranslated region (UTR). In some embodiments, the 5′ UTR is upstream of the initiation codon. In some embodiments, the 5′ UTR regulates translation of the RNA. In some embodiments, the 5′ UTR is a stabilizing sequence. In some embodiments, the 5′ UTR increases the half-life of RNA. Any 5′ UTR known in the art may be used. In some embodiments, the 5′ UTR RNA sequence is transcribed from SEQ ID NOs: 3 or 5. In some embodiments, the 5′ UTR RNA sequence comprises or consists of SEQ ID NOs: 4 or 6. In some embodiments, the 5′ UTR RNA sequence is at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% identical to SEQ ID NOs: 4 or 6.
In some embodiments, the IL-15 sushi RNA comprises a 3′ UTR. In some embodiments, the 3′ UTR follows the translation termination codon. In some embodiments, the 3′ UTR regulates polyadenylation, translation efficiency, localization, or stability of the RNA. In some embodiments, the 3′ UTR RNA sequence is transcribed from SEQ ID NO: 7. In some embodiments, the 3′ UTR RNA sequence comprises or consists of SEQ ID NO: 8. In some embodiments, the 3′ UTR RNA sequence is at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% identical to SEQ ID NO: 8.
In some embodiments, the IL-15 sushi RNA comprises both a 5′ UTR and a 3′ UTR. In some embodiments, the IL-15 sushi RNA comprises only a 5′ UTR. In some embodiments, the IL-15 sushi RNA comprises only a 3′ UTR.
In some embodiments, the IL-15 sushi RNA comprises a poly-A tail. In some embodiments, the RNA comprises a poly-A tail of at least about 25, at least about 30, at least about 50 nucleotides, at least about 70 nucleotides, or at least about 100 nucleotides. In some embodiments, the poly-A tail comprises 200 or more nucleotides. In some embodiments, the poly-A tail comprises or consists of SEQ ID NO: 30.
In some embodiments, the RNA comprises a 5′ cap, a 5′ UTR, a nucleic acid encoding IL-15 sushi, a 3′ UTR, and a poly-A tail, in that order.
In some embodiments, the IL-15 sushi RNA is encoded by a DNA sequence comprising or consisting of a nucleic acid sequence that is at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 25 and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 3 or 5.
In some embodiments, the IL-15 sushi RNA comprises an RNA sequence that is, for example, transcribed from a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 25 and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 3 or 5. The RNA may also be recombinantly produced. In some embodiments, one or more uridine in the IFNα RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U). In some embodiments, the RNA comprises a modified nucleoside in place of each uridine. In some embodiments, the modified nucleoside is N1-methyl-pseudouridine (m1ψ).
In some embodiments, the IL-15 sushi RNA comprises a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 25 and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 7.
In some embodiments, the IL-15 sushi RNA comprises an RNA sequence that is, for example, transcribed from a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 25 and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 7. The RNA may also be recombinantly produced. In some embodiments, one or more uridine in the IFNα RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U). In some embodiments, the RNA comprises a modified nucleoside in place of each uridine. In some embodiments, the modified nucleoside is N1-methyl-pseudouridine (m1ψ).
In some embodiments, the IL-15 sushi RNA comprises a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 25; at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 3 or 5; and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 7.
In some embodiments, the IL-15 sushi RNA comprises an RNA sequence that is, for example, transcribed from a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 25; at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 3 or 5; and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 7. In some embodiments, one or more uridine in the IFNα RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U). In some embodiments, the RNA comprises a modified nucleoside in place of each uridine. In some embodiments, the modified nucleoside is N1-methyl-pseudouridine (m1ψ).
In some embodiments, the IL-15 sushi RNA comprises an RNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 26; at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 4 or 6; and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 8. In some embodiments, one or more uridine in the IFNα RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U).
D. Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF)
In some embodiments, an RNA that encodes granulocyte-macrophage colony-stimulating factor (GM-CSF) is administered. In some embodiments, the GM-CSF RNA is encoded by a DNA sequence encoding granulocyte-macrophage colony-stimulating factor (GM-CSF) (e.g., SEQ ID NO: 27). In some embodiments, the DNA sequence encoding GM-CSF is provided in SEQ ID NO: 28.
In some embodiments, the GM-CSF RNA comprises an RNA sequence that is, for example, transcribed from a DNA sequence encoding GM-CSF. In some embodiments, the RNA sequence is transcribed from SEQ ID NO: 28. The RNA may also be recombinantly produced. In some embodiments, the RNA sequence comprises or consists of SEQ ID NO: 29. In some embodiments, the RNA sequence comprises an RNA sequence with 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% identity to SEQ ID NOs: 29.
In some embodiments, one or more uridine in the GM-CSF RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U). In some embodiments, the RNA comprises a modified nucleoside in place of each uridine. In some embodiments, the modified nucleoside is N1-methyl-pseudouridine (m1ψ). In some embodiments, the GM-CSF RNA comprises an altered nucleotide at the 5′ end. In some embodiments, the RNA comprises a 5′ cap. Any 5′ cap known in the art may be used. In some embodiments, the 5′ cap comprises a 5′ to 5′ triphosphate linkage. In some embodiments, the 5′ cap comprises a 5′ to 5′ triphosphate linkage including thiophosphate modification. In some embodiments, the 5′ cap comprises a 2′-O or 3′-O-ribose-methylated nucleotide. In some embodiments, the 5′ cap comprises a modified guanosine nucleotide or modified adenosine nucleotide. In some embodiments, the 5′ cap comprises 7-methylguanylate. In some embodiments, the 5′ cap is Cap0 or Cap1. Exemplary cap structures include m7G(5′)ppp(5′)G, m7,2′ O-mG(5′)ppsp(5′)G, m7G(5′)ppp(5′)2′O-mG and m7,3′O-mG(5′)ppp(5′)2′O-mA.
In some embodiments, the GM-CSF RNA comprises a 5′ untranslated region (UTR). In some embodiments, the 5′ UTR is upstream of the initiation codon. In some embodiments, the 5′ UTR regulates translation of the RNA. In some embodiments, the 5′ UTR is a stabilizing sequence. In some embodiments, the 5′ UTR increases the half-life of RNA. Any 5′ UTR known in the art may be used. In some embodiments, the 5′ UTR RNA sequence is transcribed from SEQ ID NOs: 3 or 5. In some embodiments, the 5′ UTR RNA sequence comprises or consists of SEQ ID NOs: 4 or 6. In some embodiments, the 5′ UTR RNA sequence is at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% identical to SEQ ID NOs: 4 or 6.
In some embodiments, the GM-CSF RNA comprises a 3′ UTR. In some embodiments, the 3′ UTR follows the translation termination codon. In some embodiments, the 3′ UTR regulates polyadenylation, translation efficiency, localization, or stability of the RNA. In some embodiments, the 3′ UTR RNA sequence is transcribed from SEQ ID NO: 7. In some embodiments, the 3′ UTR RNA sequence comprises or consists of SEQ ID NO: 8. In some embodiments, the 3′ UTR RNA sequence is at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% identical to SEQ ID NO: 8.
In some embodiments, the GM-CSF RNA comprises both a 5′ UTR and a 3′ UTR. In some embodiments, the RNA comprises only a 5′ UTR. In some embodiments, the composition comprises only a 3′ UTR.
In some embodiments, the GM-CSF RNA comprises a poly-A tail. In some embodiments, the RNA comprises a poly-A tail of at least about 25, at least about 30, at least about 50 nucleotides, at least about 70 nucleotides, or at least about 100 nucleotides. In some embodiments, the poly-A tail comprises 200 or more nucleotides. In some embodiments, the poly-A tail comprises or consists of SEQ ID NO: 30.
In some embodiments, the GM-CSF RNA comprises a 5′ cap, a 5′ UTR, nucleotides encoding GM-CSF, a 3′ UTR, and a poly-A tail, in that order.
In some embodiments, the GM-CSF RNA is encoded by a DNA sequence comprising or consisting of a nucleic acid sequence that is at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 28 and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 3 or 5.
In some embodiments, the GM-CSF RNA comprises an RNA sequence that is, for example, transcribed from a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 28 and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 3 or 5. The RNA may also be recombinantly produced. In some embodiments, one or more uridine in the GM-CSF RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U). In some embodiments, the RNA comprises a modified nucleoside in place of each uridine. In some embodiments, the modified nucleoside is N1-methyl-pseudouridine (m1ψ).
In some embodiments, the GM-CSF RNA is encoded by a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 28 and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 7.
In some embodiments, the GM-CSF RNA comprises an RNA sequence that is, for example, transcribed from a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 28 and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 7. The RNA may also be recombinantly produced. In some embodiments, one or more uridine in the GM-CSF RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U). In some embodiments, the RNA comprises a modified nucleoside in place of each uridine. In some embodiments, the modified nucleoside is N1-methyl-pseudouridine (m1ψ).
In some embodiments, the GM-CSF RNA comprises a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 28; at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 3 or 5; and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 7.
In some embodiments, the GM-CSF RNA comprises an RNA sequence that is, for example, transcribed from a DNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 28; at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 3 or 5; and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 7. The RNA may also be recombinantly produced. In some embodiments, one or more uridine in the GM-CSF RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U). In some embodiments, the RNA comprises a modified nucleoside in place of each uridine. In some embodiments, the modified nucleoside is N1-methyl-pseudouridine (m1ψ).
In some embodiments, the GM-CSF RNA comprises an RNA sequence comprising or consisting of a nucleic acid sequence at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 29; at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NOs: 4 or 6; and at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% identical to SEQ ID NO: 8. In some embodiments, one or more uridine in the GM-CSF RNA is replaced by a modified nucleoside as described herein. In some embodiments, the modified nucleoside replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ) or 5-methyl-uridine (m5U).
E. Modifications
Each of the RNAs described herein may be modified in any way known to those of skill in the art. In some embodiments, each RNA is modified as follows:
In some embodiments, the 5′ UTR comprises SEQ ID NOs: 4 or 6. In some embodiments, the RNA has been processed to reduce double-stranded RNA (dsRNA) as described above. The “Cap1” structure may be generated after in-vitro transcription by enzymatic capping or during in-vitro transcription (co-transcriptional capping).
In some embodiments, one or more uridine in the RNA is replaced by a modified nucleoside. In some embodiments, the modified nucleoside is a modified uridine.
In some embodiments, the modified uridine replacing uridine is pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ), or 5-methyl-uridine (m5U).
In some embodiments, one or more cytosine, adenine or guanine in the RNA is replaced by modified nucleobase(s). In one embodiment, the modified nucleobase replacing cytosine is 5-methylcytosine (m5C). In another embodiment, the modified nucleobase replacing adenine is N6-methyladenine (m6A). In another embodiment, any other modified nucleobase known in the art for reducing the immunogenicity of the molecule can be used.
In some embodiments, the modified nucleoside replacing one or more uridine in the RNA may be any one or more of 3-methyl-uridine (m3U), 5-methoxy-uridine (mo5U), 5-aza-uridine, 6-aza-uridine, 2-thio-5-aza-uridine, 2-thio-uridine (s2U), 4-thio-uridine (s4U), 4-thio-pseudouridine, 2-thio-pseudouridine, 5-hydroxy-uridine (ho5U), 5-aminoallyl-uridine, 5-halo-uridine (e.g., 5-iodo-uridineor 5-bromo-uridine), uridine 5-oxyacetic acid (cmo5U), uridine 5-oxyacetic acid methyl ester (mcmo5U), 5-carboxymethyl-uridine (cm5U), 1-carboxymethyl-pseudouridine, 5-carboxyhydroxymethyl-uridine (chm5U), 5-carboxyhydroxymethyl-uridine methyl ester (mchm5U), 5-methoxycarbonylmethyl-uridine (mcm5U), 5-methoxycarbonylmethyl-2-thio-uridine (mcm5s2U), 5-aminomethyl-2-thio-uridine (nm5s2U), 5-methylaminomethyl-uridine (mnm5U), 1-ethyl-pseudouridine, 5-methylaminomethyl-2-thio-uridine (mnm5s2U), 5-methylaminomethyl-2-seleno-uridine (mnm5se2U), 5-carbamoylmethyl-uridine (ncm5U), 5-carboxymethylaminomethyl-uridine (cmnm5U), 5-carboxymethylaminomethyl-2-thio-uridine (cmnm5s2U), 5-propynyl-uridine, 1-propynyl-pseudouridine, 5-taurinomethyl-uridine (τm5U), 1-taurinomethyl-pseudouridine, 5-taurinomethyl-2-thio-uridine (τm5s2U), 1-taurinomethyl-4-thio-pseudouridine), 5-methyl-2-thio-uridine (m5s2U), 1-methyl-4-thio-pseudouridine (m1s4ψ) 4-thio-1-methyl-pseudouridine, 3-methyl-pseudouridine (m3ψ), 2-thio-1-methyl-pseudouridine, 1-methyl-1-deaza-pseudouridine, 2-thio-1-methyl-1-deaza-pseudouridine, dihydrouridine (D), dihydropseudouridine, 5,6-dihydrouridine, 5-methyl-dihydrouridine (m5D), 2-thio-dihydrouridine, 2-thio-dihydropseudouridine, 2-methoxy-uridine, 2-methoxy-4-thio-uridine, 4-methoxy-pseudouridine, 4-methoxy-2-thio-pseudouridine, N1-methyl-pseudouridine, 3-(3-amino-3-carboxypropyl)uridine (acp3U), 1-methyl-3-(3-amino-3-carboxypropyl)pseudouridine (acp3ψ), 5-(isopentenylaminomethyl)uridine (inm5U), 5-(isopentenylaminomethyl)-2-thio-uridine (inm5s2U), α-thio-uridine, 2′-O-methyl-uridine (Um), 5,2′-O-dimethyl-uridine (m5Um), 2′-O-methyl-pseudouridine (ψm), 2-thio-2′-O-methyl-uridine (s2Um), 5-methoxycarbonylmethyl-2′-O-methyl-uridine (mcm5Um), 5-carbamoylmethyl-2′-O-methyl-uridine (ncm5Um), 5-carboxymethylaminomethyl-2′-O-methyl-uridine (cmnm5Um), 3,2′-O-dimethyl-uridine (m3Um), 5-(isopentenylaminomethyl)-2′-O-methyl-uridine (inm5Um), 1-thio-uridine, deoxythymidine, 2′-F-ara-uridine, 2′-F-uridine, 2′-OH-ara-uridine, 5-(2-carbomethoxyvinyl) uridine, 5-[3-(1-E-propenylamino)uridine, or any other modified uridine known in the art.
In some embodiments, at least one RNA comprises a modified nucleoside in place of at least one uridine. In some embodiments, at least one RNA comprises a modified nucleoside in place of each uridine. In some embodiments, each RNA comprises a modified nucleoside in place of at least one uridine. In some embodiments, each RNA comprises a modified nucleoside in place of each uridine.
In some embodiments, the modified nucleoside is independently selected from pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ), and 5-methyl-uridine (m5U). In some embodiments, the modified nucleoside comprises pseudouridine (ψ). In some embodiments, the modified nucleoside comprises N1-methyl-pseudouridine (m1ψ). In some embodiments, the modified nucleoside comprises 5-methyl-uridine (m5U). In some embodiments, at least one RNA may comprise more than one type of modified nucleoside, and the modified nucleosides are independently selected from pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ), and 5-methyl-uridine (m5U). In some embodiments, the modified nucleosides comprise pseudouridine (ψ) and N1-methyl-pseudouridine (m1ψ). In some embodiments, the modified nucleosides comprise pseudouridine (ψ) and 5-methyl-uridine (m5U). In some embodiments, the modified nucleosides comprise N1-methyl-pseudouridine (m1ψ) and 5-methyl-uridine (m5U). In some embodiments, the modified nucleosides comprise pseudouridine (ψ), N1-methyl-pseudouridine (m1ψ), and 5-methyl-uridine (m5U).
In some embodiments, at least one RNA used in the method comprises the 5′ cap) m27,3′-OGppp(m12′-O)ApG or 3′-O-Me-m7G(5′)ppp(5′)G. In some embodiments, each RNA used in the method comprises the 5′ cap m27,3′-OGppp(m12′-O)ApG or 3′-O-Me-m7G(5′)ppp(5′)G. In some embodiments, each RNA used in the method comprises the 5′ cap m27,3′-OGppp(m12′-O)ApG. In some embodiments, each RNA used in the method comprises the 3′-O-Me-m7G(5′)ppp(5′)G. In some embodiments, each RNA used in the method comprises the 5′ cap) m27,3′-OGppp(m12′-O)ApG and 3′-O-Me-m7G(5′)ppp(5′)G.
In some embodiments, at least one RNA comprises a 5′ UTR comprising a nucleotide sequence selected from the group consisting of SEQ ID NOs: 4 and 6, or a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to a nucleotide sequence selected from the group consisting of SEQ ID NOs: 4 and 6. In some embodiments, each RNA comprises a 5′ UTR comprising a nucleotide sequence selected from the group consisting of SEQ ID NOs: 4 and 6, or a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to a nucleotide sequence selected from the group consisting of SEQ ID NOs: 4 and 6.
In some embodiments, at least one RNA comprises a 3′ UTR comprising the nucleotide sequence of SEQ ID NO: 8, or a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the nucleotide sequence of SEQ ID NO: 8. In some embodiments, each RNA comprises a 3′ UTR comprising the nucleotide sequence of SEQ ID NO: 8, or a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the nucleotide sequence of SEQ ID NO: 8.
In some embodiments, at least one RNA comprises a poly-A tail. In some embodiments, each RNA comprises a poly-A tail. In some embodiments, the poly-A tail may comprise at least 20, at least 30, at least 40, at least 80, or at least 100 and up to 500, up to 400, up to 300, up to 200, or up to 150 nucleotides. In some embodiments, the poly-A tail may essentially consist of at least 20, at least 30, at least 40, at least 80, or at least 100 and up to 500, up to 400, up to 300, up to 200, or up to 150 A nucleotides. In some embodiments, the poly-A tail may consist of at least 20, at least 30, at least 40, at least 80, or at least 100 and up to 500, up to 400, up to 300, up to 200, or up to 150 nucleotides. In some embodiments, the poly-A tail may comprise the poly-A tail shown in SEQ ID NO: 30. In some embodiments, the poly-A tail comprises at least 100 nucleotides. In some embodiments, the poly-A tail comprises about 150 nucleotides. In some embodiments, the poly-A tail comprises about 120 nucleotides.
In some embodiments, one or more RNA comprises: (1) a 5′ cap comprising) m27,3′-OGppp(m12′-O)ApG or 3′-O-Me-m7G(5′)ppp(5′)G; (2) a 5′ UTR comprising (i) a nucleotide sequence selected from the group consisting of SEQ ID NOs: 4 and 6, or (ii) a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to a nucleotide sequence selected from the group consisting of SEQ ID NOs: 4 and 6; (3) a 3′ UTR comprising (i) the nucleotide sequence of SEQ ID NO: 8, or (ii) a nucleotide sequence having at least 99%, 98%, 97%, 96%, 95%, 90%, 85%, or 80% identity to the nucleotide sequence of SEQ ID NO:8; and (4) a poly-A tail comprising at least 100 nucleotides.
Cancer cells engage multiple mechanisms to evade anti-tumor host immune responses, including expression of programmed cell death-1 ligand 1 (PD-L1), the primary ligand for programmed cell death 1 receptor (PD-1), which is expressed on activated B and T lymphocytes and myeloid cells. Interaction of PD-L1 with PD-1 results in decreased immune responses and contributes to tumor evasion. An anti-PD-1 antibody is an antibody that binds to PD-1 and inhibits the interaction of PD-1 with PD-L1. Upon administration to a subject, an anti-PD-1 antibody may bind to PD-1, inhibit its binding to PD-L1, and prevent the activation of its downstream signaling pathways, including activation of T cells. In some embodiments, the cytokine RNA mixture is administered in combination with an anti-PD1 antibody.
Encompassed herein are anti-PD1 antibodies that inhibit the interaction of PD-1 with PD-L1, and inhibit the suppression of an immune response that is triggered when PD-1 interacts with PD-L1.
In some embodiments, whether or not an anti-PD1 antibody inhibits the suppression of an immune response is assessed by measuring T-cell activation (sometimes also referred to as T-cell proliferation). Such measurement may be assessed in vivo (e.g., after administration of an anti-PD1 antibody to a human subject) or in vitro (e.g., in a cell-based assay). In some embodiments, the ability of an anti-PD1 antibody to inhibit the suppression of an immune response is determined in a cell-based assay using either engineered T cell lines or primary human T cells according to the methods of Burova et al. (2017) Mol. Cancer 16(5); 861-70. For example, human PD-1 protein and a reporter are expressed in T cells and the T cells are activated with, e.g., with an anti-CD3×anti-CD20 bispecific antibody. Antigen-presenting cells (APCs), such as HEK293 cells, are generated to express human CD20 and human PD-L1. Serially diluted test anti-PD1 antibody is applied and the expression of the reporter is analyzed.
In some embodiments, the anti-PD1 antibody inhibits the suppression of an immune response that is triggered when PD-1 interacts with PD-L1 by at least 70%, at least 80%, at least 90%, or at least 95% as compared to the inhibition seen with cemiplimab. In some embodiments, whether an antibody inhibits the suppression of an immune response that is triggered when PD-1 interacts with PD-L1 by at least 70%, at least 80%, at least 90%, or at least 95% as compared to the inhibition seen with cemiplimab is assessed by measuring T-cell activation as described herein.
In some embodiments, the anti-PD1 antibody is a chimeric, humanized or human antibody. In some embodiments, the anti-PD-1 antibody is isolated and/or recombinant. In some embodiments, the anti-PD1 antibody is a multi-specific antibody such as, for example, a tri-specific or bi-specific antibody.
Non-limiting examples of anti-PD-1 antibodies include cemiplimab (see, e.g., U.S. Pat. No. 9,987,500 B2, also referred to as REGN2810, see e.g. CAS Number 1801342-60-8, and Falchook et al. J Immunother Cancer. 2016 November; 4:70), nivolumab (see, e.g., U.S. Pat. No. 8,008,449), pembrolizumab (see, e.g., U.S. Pat. No. 8,354,509), MEDI0608 (formerly AMP-514; see, e.g., U.S. Pat. Nos. 8,609,089 and 9,205,148), spartalizumab (also known as PDR001, (see, e.g., WO 2015/112900), PF-06801591 (see, e.g., WO 2016/092419), and tislelizumab (also known as BGB-A317, (see, e.g., WO 2015/035606), camrelizumab (also known as SHR-1210; see e.g., WO 2015/085847), dostarlimab (also known as TSR-042; see, e.g., WO 2014/179664), sintilimab (also known as IBI308; see, e.g., WO 2017/025016), JS001 (see, e.g., WO 2014/206107), MGA012 (see, e.g., WO 2017/019846), AGEN2034 (see, e.g., WO 2017/040790), and JNJ-63723283 (see, e.g., WO 2017/079112). The term Cemiplimab includes Cemiplimab-rwlc.
In some embodiments, the anti-PD-1 antibody is one of those disclosed in WO 2015/112800 (such as those referred to as H1M7789N, H1M7799N, H1M7800N, H2M7780N, H2M7788N, H2M7790N, H2M7791N, H2M7794N, H2M7795N, H2M7796N, H2M7798N, H4H9019P, H4xH9034P2, H4xH9035P2, H4xH9037P2, H4xH9045P2, H4xH9048P2, H4H9057P2, H4H9068P2, H4xH9119P2, H4xH9120P2, H4xH9128P2, H4xH9135P2, H4xH9145P2, H4xH8992P, H4xH8999P and H4xH9008P in Table 1 of the PCT publication, and those referred to as H4H7798N, H4H7795N2, H4H9008P and H4H9048P2 in Table 3 of the PCT publication). The disclosure of WO 2015/112800 is incorporated by reference herein in its entirety. For example, the antibodies disclosed in WO 2015/112800 and related antibodies, including antibodies and antigen-binding fragments having the CDRs, VH and VL sequences, or heavy and light chain sequences disclosed in that PCT publication, as well as antibodies and antigen-binding fragments binding to the same PD-1 epitope as the antibodies disclosed in that PCT publication, can be used in conjunction with the RNA cytokine mixture to treat and/or prevent cancer.
In some embodiments, the anti-PD-1 antibody comprises Pidilizumab (also referred to as CT-011) (Berger et al., 2008. Clin Cancer Res. 14(10):3044-51), PF-06801591 (ClinicalTrials.gov identifier: NCT02573259), mDX-400 (Merck & Co), MEDI0680 (also referred to as AMP-514) (ClinicalTrials.gov Identifier: NCT02013804), PDR001 (ClinicalTrials.gov Identifier: NCT02678260), Spartalizumab (Novartis AG, CAS Number 1935694-88-4), SHR-1210 (Incyte Corp, Jiangsu Hengrui Medicine Co Ltd, ClinicalTrials.gov Identifier: NCT02742935), TSR-042 (ClinicalTrials.gov Identifier: NCT02715284), ANA011 (AnaptysBio, Inc.), AGEN-2034 (Agenus, Inc.), AM-0001 (ARMO Biosciences), BGB-108 (BeiGene), AK-104 and AK-105 (Akeso Biopharma), ABBV-181 (AbbVie), BAT-1306 (Bio-Thera Solutions), AMP-224 (MedImmune), LZM-009 (Livzon Pharmaceutical Group), GLS-010 (Arcus Biosciences), Dostarlimab (Tesaro Inc, CAS Number 2022215-59-2), MGA-012 (Incyte Corp), Tislelizumab (BGB-A317, (BeiGene, CAS Number 1858168-59-8), BI-754091 (Boehringer Ingelheim), CBT-501 (CBT Pharmaceuticals, Inc.), ENUM-003 (Enumeral Biomedical Holdings Inc), ENUM-388D4 (Enumeral Biomedical Holdings Inc), ENUM-244C8 (Enumeral Biomedical Holdings Inc), IBI-308 (Eli Lilly Innovent Biologics, Inc.), JNJ-63723283 (Johnson & Johnson Janssen Research & Development, LLC, ClinicalTrials.gov Identifier NCT02908906), CS-1003 (CStone Pharmaceuticals), Sym-016 and Sym-021 (Symphogen), JS-001 (Shanghai Junshi Bioscience Co., Ltd., ClinicalTrials.gov Identifier NCT02857166, JTX-4014 (Jounce Therapeutics, Inc.), JY-034 (Beijing Eastern Biotech Co), SSI-361 (Lyvgen Biopharma Ltd), YBL-006 (Y-Biologics), AK-103 (Akeso Biopharma Inc), MCLA-134 (Merus), HAB-21 (Suzhou Stainwei Biotech Inc), CX-188 (CytomX Therapeutics Inc), PF-06801591 (Pfizer, ClinicalTrials.gov Identifier NCI-2016-00704), HEISCOIII-003 (Sichuan Haisco Pharmaceutical Co), XmAb-20717 (Xencor Inc, bispecific, recognizing CTLA-4 and PD1), XmAb-23104 (Xencor Inc), MGD-019 (MacroGenics Inc, bispecific, recognizing CTLA4 and PD1), AK-112 (Akeso Biopharma, bispecific), AT-16201 (AIMM Therapeutics BV), BCD-100 (Biocard), TSR-075 (Tesaro Inc, bispecific, recognizing LAG3 and PD1), MGD-013 (MacroGenics; bi-specific; recognizing PD-1 and LAG-3), BH-2922 (Beijing Hanmi Pharmaceutical Co, bispecific, recognizing EGFR and PD1), BH-2941 (Beijing Hanmi Pharmaceutical Co, bispecific, recognizing PDL1 and PD1), BH-2950 (Beijing Hanmi Pharmaceutical Co, bispecific, recognizing Her2 and PD1), BH-2954 (Beijing Hanmi Pharmaceutical Co, bispecific), STIA-1110 (Les Laboratoires Servier SAS Sorrento Therapeutics), 244C8 and 388D4 (cf. Scheuplein F et al. [abstract]. Proc 107th Ann Meet Am Ass Cane Res; 2016 Apr. 16-20; New Orleans, La. Philadelphia (Pa.): AACR; Cancer Res 2016; 76(14 Suppl):Abstract nr 4871).
In some embodiments, the anti-PD-1 antibody comprises the heavy and light chain amino acid sequences shown below as SEQ ID NOs: 31 and 32, respectively; the VH and VL sequences in SEQ ID NOs: 39 and 40 (shown in italics), or one or more (e.g., all six) CDRs in SEQ ID NOs: 31 and 32 (shown in bold boxes). In some embodiments, an antibody comprising the following CDRs is encompassed:
In some embodiments, the anti-PD-1 antibody comprises HCDR3 (SEQ ID NO: 35). In some embodiments, the anti-PD-1 antibody comprises LCDR3 (SEQ ID NO: 38). In some embodiments, the anti-PD-1 antibody comprises HCDR3 (SEQ ID NO: 35) and LCDR3 (SEQ ID NO: 38).
In some embodiments, the anti-PD1 antibody comprises HCDR3 (SEQ ID NO: 35) and/or LCDR3 (SEQ ID NO: 38), and inhibits the interaction of PD-1 with PD-L1. In some embodiments, the anti-PD1 antibody comprises HCDR3 (SEQ ID NO: 35) and/or LCDR3 (SEQ ID NO: 38), and inhibits the suppression of an immune response that is triggered when PD-1 interacts with PD-L1. In some embodiments, the anti-PD1 antibody comprises HCDR3 (SEQ ID NO: 35) and/or LCDR3 (SEQ ID NO: 38), and inhibits the interaction of PD-1 with PD-L1, and inhibits the suppression of an immune response that is triggered when PD-1 interacts with PD-L1.
In some embodiments, the anti-PD1 antibody is cemiplimab. In some embodiments, the anti-PD1 antibody is an antibody that binds to the same epitope as cemiplimab. In some embodiments, the anti-PD1 antibody competes with cemiplimab for PD-1 binding. In some embodiments, whether an antibody competes with cemiplimab for PD-1 binding is determined via ELISA according to methods known to those of skill in the art, e.g., as in Burova et al. (2017) Mol. Cancer 16(5); 861-70. In short, a test antibody, cemiplimab, and a negative isotype control antibody are incubated with PD-1 and transferred to the wells of an ELISA plate coated with PD-L1. Bound antibody is detected after appropriate washing and application of labelled secondary antibody.
In some embodiments, the anti-PD1 antibody inhibits the interaction of PD-1 with PD-L1 by at least 70%, at least 80%, at least 90%, or at least 95% as compared to the level of inhibition seen with cemiplimab. In some embodiments, whether an antibody inhibits the interaction of PD-1 with PD-L1 by at least 70%, at least 80%, at least 90%, or at least 95% as compared to the level of inhibition seen with cemiplimab is assessed via ELISA as described herein.
Cemiplimab is currently being investigated in phase 1 clinical studies as monotherapy and in combination with other anti-cancer therapies, as well as in phase 2 and 3 clinical studies in patients with advanced cutaneous squamous cell carcinoma, basal cell carcinoma, non-small cell lung cancer, cervical cancer, and other solid tumors. Preliminary efficacy was observed in several tumor types, including non-small cell lung cancer, at both 1 mg/kg administered every 2 weeks (Q2W) and 3 mg/kg Q2W doses.
As of 27 Mar. 2018, 757 patients were enrolled and treated with cemiplimab as monotherapy as well as in combination with radiation therapy and/or other cancer therapy at different dose levels (1, 3, or 10 mg/kg or 200 mg Q2W; and 3 mg/kg, 250 mg, or 350 mg Q3W). The efficacy of cemiplimab against advanced CSCC has been clearly documented in a phase 2 study, and on 28 Sep. 2018 cemiplimab received approval in the United States for the treatment of patients with metastatic CSCC or locally advanced CSCC who are not candidates for curative surgery or curative radiation. Cemiplimab was also approved in Europe for the same indication on Jun. 28, 2019.
Cemiplimab has a safety profile similar to that of other PD-1 inhibitors. The most common treatment-emergent adverse events (TEAEs) occurring in 10% or more of patients were fatigue, nausea, anemia, decreased appetite, arthralgia, constipation, cough, vomiting, and abdominal pain.
Compositions and methods of using and making Cemiplimab are disclosed, for example, in the published U.S. Patent Application No. 2015/0203579, the content of which is hereby incorporated by reference herein in its entirety for any purpose.
The anti-PD-1 antibody may be formulated with suitable carriers, excipients, and other agents that provide suitable transfer, delivery, tolerance, and the like. A multitude of appropriate formulations can be found in the formulary known to all pharmaceutical chemists: Remington's Pharmaceutical Sciences, Mack Publishing Company, Easton, Pa. These formulations include, for example, powders, pastes, ointments, jellies, waxes, oils, lipids, lipid (cationic or anionic) containing vesicles, DNA conjugates, anhydrous absorption pastes, oil-in-water and water-in-oil emulsions, emulsions carbowax (polyethylene glycols of various molecular weights), semi-solid gels, and semi-solid mixtures containing carbowax. See Powell et al. “Compendium of excipients for parenteral formulations” PDA (1998) J Pharm Sci Technol 52:238-311.
The cytokine RNA mixture provided herein may be used in methods, e.g., therapeutic methods, in combination with an anti-PD-1 antibody. In some embodiments, methods for treating advanced-stage, unresectable, or metastatic solid tumor cancers are encompassed, comprising administering the cytokine RNA mixture and an anti-PD-1 antibody, wherein the advanced-stage solid tumor cancer comprises an epithelial tumor, prostate tumor, ovarian tumor, renal cell tumor, gastrointestinal tract tumor, hepatic tumor, colorectal tumor, tumor with vasculature, mesothelioma tumor, pancreatic tumor, breast tumor, sarcoma tumor, lung tumor, colon tumor, melanoma tumor, small cell lung tumor, neuroblastoma tumor, testicular tumor, carcinoma tumor, adenocarcinoma tumor, seminoma tumor, retinoblastoma, cutaneous squamous cell carcinoma (CSCC), lymphoma, including Non-Hodgkin lymphoma and Hodgkin lymphoma, squamous cell carcinoma for the head and neck (HNSCC), head and neck cancer, osteosarcoma tumor, non-small cell lung cancer, kidney tumor, thyroid tumor, liver tumor, other solid tumors amenable to intratumoral injection, or combinations thereof.
In some embodiments, the advanced-stage solid tumor cancer comprises an epithelial tumor, prostate tumor, ovarian tumor, renal cell tumor, gastrointestinal tract tumor, hepatic tumor, colorectal tumor, tumor with vasculature, mesothelioma tumor, pancreatic tumor, breast tumor, sarcoma tumor, lung tumor, colon tumor, melanoma tumor, small cell lung tumor, neuroblastoma tumor, testicular tumor, carcinoma tumor, adenocarcinoma tumor, seminoma tumor, retinoblastoma, cutaneous squamous cell carcinoma (CSCC), squamous cell carcinoma for the head and neck (HNSCC), head and neck cancer, osteosarcoma tumor, non-small cell lung cancer, kidney tumor, thyroid tumor, liver tumor, other solid tumors amenable to intratumoral injection, or combinations thereof.
In some embodiments, the advanced-stage solid tumor cancer comprises lymphoma, such as Non-Hodgkin lymphoma or Hodgkin lymphoma.
In some embodiments, the solid tumor cancer is melanoma. In some embodiments, the melanoma is uveal melanoma or mucosal melanoma. In some embodiments, the solid tumor cancer is melanoma, optionally uveal melanoma or mucosal melanoma, and comprises superficial, subcutaneous and/or lymph node metastases amenable for intratumoral injection.
In some embodiments, intratumoral injection comprises injection into a solid tumor metastasis within a lymph node. In some embodiments, intratumoral injection comprises injection into a lymphoma tumor within a lymph node. In some embodiments, intratumoral injection comprises injection into a primary or secondary solid tumor that is within 10 cm of the subject's skin surface. In some embodiments, intratumoral injection comprises injection into a primary or secondary solid tumor that is within 5 cm of the subject's skin surface. In some embodiments, intratumoral injection comprises injection into a cutaneous solid tumor. In some embodiments, the cutaneous solid tumor is a metastasis. In some embodiments, the cutaneous solid tumor is a skin cancer. In some embodiments, the cutaneous solid tumor is not a skin cancer. In some embodiments, intratumoral injection comprises injection into a subcutaneous solid tumor. In some embodiments, the subcutaneous solid tumor is a metastasis. In some embodiments, the subcutaneous solid tumor is a skin cancer. In some embodiments, the subcutaneous solid tumor is not a skin cancer.
In some embodiments, the solid tumor is an epithelial tumor. In some embodiments, the solid tumor is a prostate tumor. In some embodiments, the solid tumor is an ovarian tumor. In some embodiments, the solid tumor is a renal cell tumor. In some embodiments, the solid tumor is a gastrointestinal tract tumor. In some embodiments, the solid tumor is a hepatic tumor. In some embodiments, the solid tumor is a colorectal tumor. In some embodiments, the solid tumor is a tumor with vasculature. In some embodiments, the solid tumor is a mesothelioma tumor. In some embodiments, the solid tumor is a pancreatic tumor. In some embodiments, the solid tumor is a breast tumor. In some embodiments, the solid tumor is a sarcoma tumor. In some embodiments, the solid tumor is a lung tumor. In some embodiments, the solid tumor is a colon tumor. In some embodiments, the solid tumor is a melanoma tumor. In some embodiments, the solid tumor is a small cell lung tumor. In some embodiments, the solid tumor is non-small cell lung cancer tumor. In some embodiments, the solid tumor is a neuroblastoma tumor. In some embodiments, the solid tumor is a testicular tumor. In some embodiments, the solid tumor is a carcinoma tumor. In some embodiments, the solid tumor is an adenocarcinoma tumor. In some embodiments, the solid tumor is a seminoma tumor. In some embodiments, the solid tumor is a retinoblastoma. In some embodiments, the solid tumor is a cutaneous squamous cell carcinoma (CSCC). In some embodiments, the solid tumor is a squamous cell carcinoma for the head and neck (HNSCC). In some embodiments, the solid tumor is HNSCC. In some embodiments, the solid tumor is head and neck cancer. In some embodiments, the solid tumor is an osteosarcoma tumor. In some embodiments, the solid tumor is kidney cancer. In some embodiments, the solid tumor is thyroid cancer. In some embodiments, the solid tumor is anaplastic thyroid cancer (ATC). In some embodiments, the solid tumor is liver cancer. In some embodiments, the solid tumor is a colon tumor. In some embodiments, the solid tumor is any two of the above. In some embodiments, the solid tumor is any two or more of the above.
In some embodiments, the solid tumor is lymphoma. In some embodiments, the solid tumor is Non-Hodgkin lymphoma. In some embodiments, the solid tumor is Hodgkin lymphoma.
In some embodiments, the method comprises the use of a cytokine RNA mixture comprising RNA encoding IFNα, RNA encoding IL-15 sushi, RNA encoding IL-12sc, and RNA encoding GM-CSF, optionally modified to have a modified nucleobase in place of each uridine and a Cap1 structure at the 5′ end of the RNA, in combination with an anti-PD-1 antibody.
In some embodiments, a method for treating an advanced-stage, unresectable, or metastatic solid tumor cancer is provided comprising administering to a subject having an advanced-stage, unresectable, or metastatic solid tumor cancer RNA encoding an IL-12sc protein, RNA encoding an IL-15 sushi protein, RNA encoding an IFNα protein, and RNA encoding a GM-CSF protein, in combination with an anti-PD-1 antibody.
In some embodiments, methods for treating advanced-stage, unresectable, or metastatic solid tumor cancers are encompassed comprising administering to a subject having an advanced-stage solid tumor cancer a therapeutically effective amount of RNA comprising RNA encoding an IL-12sc protein, RNA encoding an IL-15 sushi protein, RNA encoding an IFNα protein, and RNA encoding a GM-CSF protein and a therapeutically effective amount of an anti-PD-1 antibody.
In some embodiments, a method for in treating advanced-stage, unresectable, or metastatic solid tumor cancers is encompassed comprising administering RNA encoding IL-12sc and further administering an RNA encoding IFNα, IL-15 sushi, and GM-CSF, and further administering an anti-PD-1 antibody.
In some embodiments, a method for treating advanced-stage, unresectable, or metastatic solid tumor cancers is encompassed comprising administering RNA encoding IFNα and further administering an RNA encoding IL-12sc, IL-15 sushi, and GM-CSF, and further administering an anti-PD-1 antibody.
In some embodiments, a method for treating advanced-stage, unresectable, or metastatic solid tumor cancers is encompassed comprising administering RNA encoding IL-15 sushi and further administering an RNA encoding IL-12sc, IFNα, and GM-CSF, and further administering an anti-PD-1 antibody.
In some embodiments, a method for treating advanced-stage, unresectable, or metastatic solid tumor cancers is encompassed comprising administering RNA encoding GM-CSF sushi and further administering an RNA encoding IL-12sc, IFNα, and IL-15 sushi, and further administering an anti-PD-1 antibody.
In some embodiments, methods for treating advanced-stage, unresectable, or metastatic solid tumor cancers are encompassed comprising administering to a subject having an advanced-stage solid tumor cancer a therapeutically effective amount of 1) RNA comprising RNA encoding an IL-12sc protein, RNA encoding an IL-15 sushi protein, RNA encoding an IFNα protein, and RNA encoding a GM-CSF protein and 2) an anti-PD-1 antibody.
As used herein, “a/an/the RNAs/anti-PD-1 antibody combination” refers to administering RNA cytokine mixture in combination with an anti-PD1 antibody.
In some embodiments, the co-administration of the RNAs and the an anti-PD-1 antibody result in one or more of: (a) a reduction in the severity or duration of a symptom of cancer; (b) inhibition of tumor growth, or an increase in tumor necrosis, tumor shrinkage and/or tumor disappearance; (c) delay in tumor growth and/or development; (d) inhibited or retarded or stopped tumor metastasis; (e) prevention or delay of recurrence of tumor growth; (f) increase in survival of a subject; and/or (g) a reduction in the use or need for conventional anti-cancer therapy (e.g., reduced or eliminated use of chemotherapeutic or cytotoxic agents) as compared to an untreated subject or a subject administered the RNAs or the anti-PD-1 antibody as monotherapy.
Any other treatment options known in the art for treating solid tumors may be combined with the methods disclosed herein. In some instances, the cytokine RNA mixture and anti-PD-1 antibody is administered in combination with one or more other treatment options (e.g., chemotherapeutic agents, including another immune stimulator, immunotherapy, or checkpoint modulator; or radiation).
In some embodiments, the RNAs or the cytokine RNA mixture are delivered via injection into the tumor (e.g., intratumorally), or near the tumor (peri-tumorally) and the anti-PD1 antibody is delivered in the same manner or systemically, for example, intravenous, enteral or parenteral, including, via injection, infusion, and implantation. The RNAs and antibody may be co-administered, e.g., concurrently, simultaneously or sequentially. If sequential, administration can be in any order and at any appropriate time intervals known to those of skill in the art.
In some embodiments, the RNAs are injected intratumorally or peritumorally and the anti-PD-1 antibody is administered intravenously. In some embodiments, the RNAs are injected intratumorally and the anti-PD-1 antibody is administered intravenously.
In some embodiments, the cytokine RNA mixture is administered intratumorally once per week in a 3- or 4-week cycle (i.e., three doses every 21 or four doses every 28 days) and the anti-PD1 antibody is administered systemically, e.g., intravenously only one time during this 21- or 28-day cycle, optionally on the first day of treatment. In some embodiments, the cytokine RNA mixture is administered intratumorally or peritumorally once per week with an anti-PD1 antibody administered intravenously on day 1 of a 3-week cycle (i.e., three doses of the cytokine RNA mixture and one dose of an anti-PD1 antibody every 21 days). In some embodiments, the cytokine RNA mixture is administered intratumorally or peritumorally once per week with an anti-PD1 antibody administered intravenously on day 1 of a 4-week cycle (i.e., four doses of the cytokine RNA mixture and one dose of an anti-PD1 antibody every 28 days). In some embodiments, intratumoral injection continues weekly until the second tumor assessment, at which time a change of the dose interval of the cytokine RNA mixture to every three weeks may be made. In some embodiments, the RNAs and the anti-PD-1 antibody are administered at the same dosing frequency (e.g., dosed together or separately on the same days). In some embodiments, the RNAs and the anti-PD-1 antibody are administered at a different dosing frequency (e.g., on different days). In some embodiments, the RNAs are administered once every week, and the anti-PD-1 antibody is administered once every three weeks.
In some embodiments, the cytokine RNA mixture and anti-PD1 are co-administered on a 3- or 4-week cycle, wherein the cytokine RNA mixture is administered once every week, and the anti-PD1 antibody is administered only once.
In some embodiments, the cytokine RNA mixture and anti-PD1 are co-administered on a 3- or 4-week cycle, wherein the cytokine RNA mixture is administered once every 2 weeks, and the anti-PD1 antibody is administered only once. In some embodiments, the cytokine RNA mixture and anti-PD1 are co-administered on a 3- or 4-week cycle, wherein the cytokine RNA mixture is administered once every 3 weeks, and the anti-PD1 antibody is administered only once.
In some embodiments, the cytokine RNA mixture and anti-PD1 are co-administered on a 3- or 4-week cycle, wherein the cytokine RNA mixture is administered once every 4 weeks, and the anti-PD1 antibody is administered only once.
In some embodiments, combinations of RNA are administered as a 1:1:1:1 ratio based on equal RNA mass (i.e., 1:1:1:1% (w/w/w/w)).
In some embodiments, the RNAs/anti-PD-1 antibody combination described herein are administered for about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12 months. In some embodiments, the RNAs/anti-PD-1 antibody combination is administered for about 8 months. In some embodiments, the RNAs/anti-PD-1 antibody combination is administered for a maximum of 52 weeks.
In some embodiments, the anti-PD1 antibody is administered via injection. In some embodiments, the anti-PD1 antibody is administered intravenously. In some embodiments, the anti-PD-1 antibody is administered intravenously once every three weeks and the cytokine RNA mixture is administered intratumorally or peri-tumorally once every week.
In some embodiments, the anti-PD-1 antibody is administered once every three weeks intravenously and the cytokine RNA mixture is administered once every week intra- or peri-tumorally.
In some embodiments, the RNAs are administered in a therapeutically effective amount. In some embodiments, the anti-PD-1 antibody is administered in a therapeutically effective amount. In some embodiments, the therapeutically effective amount is an amount that differs from the therapeutically effective amount for each component individually as monotherapy.
In some embodiments, the anti-PD1 antibody is administered at a dose from about 0.05 mg to about 600 mg, e.g., about 0.05 mg, about 0.1 mg, about 1.0 mg, about 1.5 mg, about 2.0 mg, about 10 mg, about 20 mg, about 30 mg, about 40 mg, about 50 mg, about 60 mg, about 70 mg, about 80 mg, about 90 mg, about 100 mg, about 110 mg, about 120 mg, about 130 mg, about 140 mg, about 150 mg, about 160 mg, about 170 mg, about 180 mg, about 190 mg, about 200 mg, about 210 mg, about 220 mg, about 230 mg, about 240 mg, about 250 mg, about 260 mg, about 270 mg, about 280 mg, about 290 mg, about 300 mg, about 310 mg, about 320 mg, about 330 mg, about 340 mg, about 350 mg, about 360 mg, about 370 mg, about 380 mg, about 390 mg, about 400 mg, about 410 mg, about 420 mg, about 430 mg, about 440 mg, about 450 mg, about 460 mg, about 470 mg, about 480 mg, about 490 mg, about 500 mg, about 510 mg, about 520 mg, about 530 mg, about 540 mg, about 550 mg, about 560 mg, about 570 mg, about 580 mg, about 590 mg, or about 600 mg.
In some embodiments, 200 mg of an anti-PD-1 antibody is administered. In some embodiments, 240 mg of an anti-PD-1 antibody is administered. In some embodiments, 350 mg of an anti-PD-1 antibody is administered. In some embodiments, the anti-PD-1 antibody is cemiplimab and 350 mg of cemiplimab is administered.
The amount of anti-PD-1 antibody contained within the individual doses may be expressed in terms of milligrams of antibody per kilogram of subject body weight (i.e., mg/kg). In certain embodiments, anti-PD-1 antibody used in the methods described herein may be administered to a subject at a dose of about 0.0001 to about 100 mg/kg of subject body weight. For example, anti-PD-1 antibody may be administered at dose of about 0.1 mg/kg to about 20 mg/kg of a patient's body weight.
In some embodiments, the anti-PD-1 antibody is cemiplimab and is administered at dose of about 3 mg/kg of a patient's body weight.
In some embodiments, multiple doses of an anti-PD-1 may be administered to a subject over a defined time course. In some embodiments, a method comprises sequentially administering to a subject one or more doses of an anti-PD-1 antibody. As used herein, “sequentially administering” means that each dose of the antibody is administered to the subject at a different point in time, e.g., on different days separated by a predetermined interval (e.g., hours, days, weeks or months). In some embodiments, the methods comprise sequentially administering to the patient a single initial dose of an anti-PD-1 antibody, followed by one or more secondary doses of the anti-PD-1 antibody, and optionally followed by one or more tertiary doses of the anti-PD-1 antibody.
The terms “initial dose,” “secondary doses,” and “tertiary doses,” refer to the temporal sequence of administration. Thus, the “initial dose” is the dose which is administered at the beginning of the treatment regimen (also referred to as the “baseline dose”); the “secondary doses” are the doses which are administered after the initial dose; and the “tertiary doses” are the doses which are administered after the secondary doses. The initial, secondary, and tertiary doses may all contain the same amount of the antibody (anti-PD-1 antibody). In certain embodiments, however, the amount contained in the initial, secondary and/or tertiary doses varies from one another (e.g., adjusted up or down as appropriate) during the course of treatment. In certain embodiments, one or more (e.g., 1, 2, 3, 4, or 5) doses are administered at the beginning of the treatment regimen as “loading doses” followed by subsequent doses that are administered on a less frequent basis (e.g., “maintenance doses”). For example, an anti-PD-1 antibody may be administered to a patient at a loading dose of about 1-3 mg/kg followed by one or more maintenance doses of about 0.1 to about 20 mg/kg of the patient's body weight.
In some embodiments, each secondary and/or tertiary dose is administered ½ to 14 (e.g., ½, 1, 1½, 2, 2½, 3, 3½, 4, 4½, 5, 5½, 6, 6½, 7, 7½, 8, 8½, 9, 9½, 10, 10½, 11, 11½, 12, 12½, 13, 13½, 14, 14½, or more) weeks after the immediately preceding dose. The phrase “the immediately preceding dose,” as used herein, means, in a sequence of multiple administrations, the dose of anti-PD-1 antibody which is administered to a patient prior to the administration of the very next dose in the sequence with no intervening doses.
In some embodiments, the methods may comprise administering to a patient any number of secondary and/or tertiary doses of an anti-PD-1 antibody. For example, in some embodiments, only a single secondary dose is administered to the patient. In other embodiments, two or more (e.g., 2, 3, 4, 5, 6, 7, 8, or more) secondary doses are administered to the patient. Likewise, in certain embodiments, only a single tertiary dose is administered to the patient. In other embodiments, two or more (e.g., 2, 3, 4, 5, 6, 7, 8, or more) tertiary doses are administered to the patient.
In some embodiments involving multiple secondary doses, each secondary dose may be administered at the same frequency as the other secondary doses. For example, each secondary dose may be administered to the patient 1 to 2 weeks after the immediately preceding dose. Similarly, in some embodiments involving multiple tertiary doses, each tertiary dose may be administered at the same frequency as the other tertiary doses. For example, each tertiary dose may be administered to the patient 2 to 4 weeks after the immediately preceding dose. Alternatively, the frequency at which the secondary and/or tertiary doses are administered to a patient can vary over the course of the treatment regimen. The frequency of administration may also be adjusted during the course of treatment by a physician depending on the needs of the individual patient following clinical examination.
In some embodiments, one or more doses of an anti-PD-1 antibody are administered at the beginning of a treatment regimen as “induction doses” on a more frequent basis (twice a week, once a week or once in 2 weeks) followed by subsequent doses (“consolidation doses” or “maintenance doses”) that are administered on a less frequent basis (e.g., once in 4-12 weeks).
In some embodiments, the RNAs are administered in a neoadjuvant setting. “Neoadjuvant setting” refers to a clinical setting in which the method is carried out before the primary/definitive therapy (e.g., before surgical resection of the tumor).
Anti-PD-1 Antibody Dosing
In some embodiments, the anti-PD-1 antibody is administered at a dose from about 0.05 mg to about 600 mg, e.g., about 0.05 mg, about 0.1 mg, about 1.0 mg, about 1.5 mg, about 2.0 mg, about 10 mg, about 20 mg, about 30 mg, about 40 mg, about 50 mg, about 60 mg, about 70 mg, about 80 mg, about 90 mg, about 100 mg, about 110 mg, about 120 mg, about 130 mg, about 140 mg, about 150 mg, about 160 mg, about 170 mg, about 180 mg, about 190 mg, about 200 mg, about 210 mg, about 220 mg, about 230 mg, about 240 mg, about 250 mg, about 260 mg, about 270 mg, about 280 mg, about 290 mg, about 300 mg, about 310 mg, about 320 mg, about 330 mg, about 340 mg, about 350 mg, about 360 mg, about 370 mg, about 380 mg, about 390 mg, about 400 mg, about 410 mg, about 420 mg, about 430 mg, about 440 mg, about 450 mg, about 460 mg, about 470 mg, about 480 mg, about 490 mg, about 500 mg, about 510 mg, about 520 mg, about 530 mg, about 540 mg, about 550 mg, about 560 mg, about 570 mg, about 580 mg, about 590 mg, or about 600 mg.
In some embodiments, 200 mg of an anti-PD-1 antibody is administered. In some embodiments, 240 mg of an anti-PD-1 antibody is administered. In some embodiments, 350 mg of an anti-PD-1 antibody is administered. In some embodiments, the anti-PD-1 antibody is cemiplimab and 350 mg of cemiplimab is administered.
The amount of anti-PD-1 antibody contained within the individual doses may be expressed in terms of milligrams of antibody per kilogram of subject body weight (i.e., mg/kg). In certain embodiments, anti-PD-1 antibody used in the methods described herein may be administered to a subject at a dose of about 0.0001 to about 100 mg/kg of subject body weight. For example, anti-PD-1 antibody may be administered at dose of about 0.1 mg/kg to about 20 mg/kg of a patient's body weight.
In some embodiments, the anti-PD-1 antibody is cemiplimab and is administered at dose of about 3 mg/kg of a patient's body weight.
In some embodiments, multiple doses of an anti-PD-1 may be administered to a subject over a defined time course. In some embodiments, a method comprises sequentially administering to a subject one or more doses of an anti-PD-1 antibody. As used herein, “sequentially administering” means that each dose of the antibody is administered to the subject at a different point in time, e.g., on different days separated by a predetermined interval (e.g., hours, days, weeks or months). In some embodiments, the methods comprise sequentially administering to the patient a single initial dose of an anti-PD-1 antibody, followed by one or more secondary doses of the anti-PD-1 antibody, and optionally followed by one or more tertiary doses of the anti-PD-1 antibody.
The terms “initial dose,” “secondary doses,” and “tertiary doses,” refer to the temporal sequence of administration. Thus, the “initial dose” is the dose which is administered at the beginning of the treatment regimen (also referred to as the “baseline dose”); the “secondary doses” are the doses which are administered after the initial dose; and the “tertiary doses” are the doses which are administered after the secondary doses. The initial, secondary, and tertiary doses may all contain the same amount of the antibody (anti-PD-1 antibody). In certain embodiments, however, the amount contained in the initial, secondary and/or tertiary doses varies from one another (e.g., adjusted up or down as appropriate) during the course of treatment. In certain embodiments, one or more (e.g., 1, 2, 3, 4, or 5) doses are administered at the beginning of the treatment regimen as “loading doses” followed by subsequent doses that are administered on a less frequent basis (e.g., “maintenance doses”). For example, an anti-PD-1 antibody may be administered to a patient at a loading dose of about 1-3 mg/kg followed by one or more maintenance doses of about 0.1 to about 20 mg/kg of the patient's body weight.
In some embodiments, each secondary and/or tertiary dose is administered ½ to 14 (e.g., ½, 1, 1½, 2, 2½, 3, 3½, 4, 4½, 5, 5½, 6, 6½, 7, 7½, 8, 8½, 9, 9½, 10, 10½, 11, 11½, 12, 12½, 13, 13½, 14, 14½, or more) weeks after the immediately preceding dose. The phrase “the immediately preceding dose,” as used herein, means, in a sequence of multiple administrations, the dose of anti-PD-1 antibody which is administered to a patient prior to the administration of the very next dose in the sequence with no intervening doses.
In some embodiments, the methods may comprise administering to a patient any number of secondary and/or tertiary doses of an anti-PD-1 antibody. For example, in some embodiments, only a single secondary dose is administered to the patient. In other embodiments, two or more (e.g., 2, 3, 4, 5, 6, 7, 8, or more) secondary doses are administered to the patient. Likewise, in certain embodiments, only a single tertiary dose is administered to the patient. In other embodiments, two or more (e.g., 2, 3, 4, 5, 6, 7, 8, or more) tertiary doses are administered to the patient.
In some embodiments involving multiple secondary doses, each secondary dose may be administered at the same frequency as the other secondary doses. For example, each secondary dose may be administered to the patient 1 to 2 weeks after the immediately preceding dose. Similarly, in some embodiments involving multiple tertiary doses, each tertiary dose may be administered at the same frequency as the other tertiary doses. For example, each tertiary dose may be administered to the patient 2 to 4 weeks after the immediately preceding dose. Alternatively, the frequency at which the secondary and/or tertiary doses are administered to a patient can vary over the course of the treatment regimen. The frequency of administration may also be adjusted during the course of treatment by a physician depending on the needs of the individual patient following clinical examination.
In some embodiments, one or more doses of an anti-PD-1 antibody are administered at the beginning of a treatment regimen as “induction doses” on a more frequent basis (twice a week, once a week or once in 2 weeks) followed by subsequent doses (“consolidation doses” or “maintenance doses”) that are administered on a less frequent basis (e.g., once in 4-12 weeks).
In some embodiments, the RNAs/anti-PD-1 antibody combination provided herein is used in a method of treating a subject having a solid tumor. In some embodiments, the subject:
In some embodiments, the RNAs/anti-PD-1 antibody combination provided herein is used in a method of treating a solid tumor in a subject that has failed an anti-programmed cell death 1 (PD-1) or anti-programmed cell death 1 ligand (PD-L1) therapy.
In some embodiments, the RNAs/anti-PD-1 antibody combination provided herein is used in a method of treating a solid tumor in a subject that has become intolerant to an anti-programmed cell death 1 (PD-1) or anti-programmed cell death 1 ligand (PD-L1) therapy.
In some embodiments, the RNAs/anti-PD-1 antibody combination provided herein is used in a method of treating a solid tumor in a subject that has become resistant an anti-programmed cell death 1 (PD-1) or anti-programmed cell death 1 ligand (PD-L1) therapy.
In some embodiments, the RNAs/anti-PD-1 antibody combination provided herein is used in a method of treating a solid tumor in a subject that has become intolerant an anti-programmed cell death 1 (PD-1) or anti-programmed cell death 1 ligand (PD-L1) therapy.
In some embodiments, the RNAs/anti-PD-1 antibody combination provided herein is used in a method of treating a solid tumor in a subject that has a PD-1 and/or PD-L1 resistant solid tumor.
In some embodiments, the RNAs/anti-PD-1 antibody combination provided herein is used in a method of treating a solid tumor in a subject, wherein the subject has acquired resistance to an anti-PD-1 and/or anti-PD-L1 therapy.
In some embodiments, the RNAs/anti-PD-1 antibody combination provided herein is used in a method of treating a solid tumor in a subject, wherein the subject has innate resistance to an anti-PD-1 and/or anti-PD-L1 therapy.
In some embodiments, the subject has a metastatic solid tumor. In some embodiments, the subject has an unresectable solid tumor. In some embodiments, the subject has an advanced-stage solid tumor. In some embodiments, the subject has a metastatic solid tumor cancer. In some embodiments, the subject has an advanced stage, unresectable, and metastatic solid tumor. In some embodiments, the subject has an advanced stage and unresectable solid tumor. In some embodiments, the subject has an advanced stage and metastatic solid tumor. In some embodiments, the subject has an unresectable and metastatic solid tumor.
In some embodiments, the subject has a cancer cell comprising a partial or total loss of beta-2-microglobulin (B2M) function. In some embodiments, the subject has a cancer cell with a partial loss of B2M function. In some embodiments, the subject has a cancer cell has a total loss of B2M function. In some embodiments, the partial or total loss of B2M function is assessed by comparing a cancer cell to a non-cancer cell from the same subject, wherein the non-cancer cell is from the same tissue from which the cancer cell was derived. In some embodiments, the partial or total loss of B2M function is assessed by comparing a cancer cell to a non-cancer cell from the same subject, wherein the non-cancer cell is not from the same tissue from which the cancer cell was derived. In some embodiments, the partial or total loss of B2M function is assessed by comparing a cancer cell to a non-cancer cell from a different subject. In some embodiments, the partial or total loss of B2M function is assessed by comparing a cancer cell to a non-cancer cell control.
In some embodiments, the cancer cell is in a solid tumor that comprises cancer cells with normal B2M function. In some embodiments, the cancer cell is in a solid tumor in which 25% or more of the cancer cells have a partial or total loss in B2M function. In some embodiments, the cancer cell is in a solid tumor in which 50% or more of the cancer cells have a partial or total loss in B2M function. In some embodiments, the cancer cell is in a solid tumor in which 75% or more of the cancer cells have a partial or total loss in B2M function. In some embodiments, the cancer cell is in a solid tumor in which 95% or more of the cancer cells have a partial or total loss in B2M function.
In some embodiments, the subject comprises a cell comprising a mutation in the B2M gene.
In some embodiments, the mutation is a substitution, insertion, or deletion. In some embodiments, the B2M gene comprises a loss of heterozygosity (LOH). In some embodiments, the mutation is a frameshift mutation. In some embodiments, the mutation is a deletion mutation. In some embodiments, the frameshift mutation is in exon 1 of B2M. In some embodiments, the frameshift mutation results in a truncation of B2M. In some embodiments, the mutation is a complete or partial deletion (e.g., truncation) of B2M. In some embodiments, a deletion mutation is in exon 1 of B2M. In some embodiments, the frameshift mutation comprises p.Leu13fs and/or p.Ser14fs. In some embodiments, the frameshift mutation comprises V69Wfs*34, L15fs*41, L13P, L15fs*41, and/or p.S31* according to Middha et al. (2019) JCO Precis Oncol. (doi:10.1200/P0.18.00321). In some embodiments, the mutation comprises a frameshift and/or deletion (e.g., truncation) mutation upstream of a kinase domain for JAK1 and/or JAK2.
In some embodiments, the subject has a reduced level of B2M protein as compared to a subject without a partial or total loss of B2M function.
In some embodiments, the subject comprises a partial or total loss of beta-2-microglobulin (B2M) function. In some embodiments, the subject comprises a partial loss of B2M function. In some embodiments, the subject comprises a total loss of B2M function. The partial or total loss of B2M function may be assessed by comparing to a tissue sample from the same subject. The partial or total loss of B2M function may be assessed by comparing a tissue sample from the tumor to a tissue sample from the same tissue from which the tumor sample was derived.
In some embodiments, the solid tumor as a whole (e.g., as assessed in a biopsy taken from the solid tumor) has a partial or total loss of B2M function compared to normal cells or tissue from which the solid tumor is derived. In some embodiments, the subject comprises (e.g., the partial or total loss of function results from) a mutation in the B2M gene.
In some embodiments, certain cells within the tumor have a B2M loss of function. In some embodiment, certain cells within the tumor have a partial or total loss of B2M function while other cells in the tumor do not.
In some embodiments, the subject has a reduced level of surface expressed major histocompatibility complex class I (MHC I) as compared to a control, optionally wherein the control is a non-cancerous sample from the same subject. In some embodiments, a subject has a cancer cell comprising a reduced level of surface expressed MHC I. In some embodiments, the cancer cell has no surface expressed MHC I. In some embodiments, the reduced level of surface expressed MHC I is assessed by comparing a cancer cell to a non-cancer cell from the same subject, optionally wherein the non-cancer cell is from the same tissue from which the cancer cell was derived. In some embodiments, the cancer cell is in a solid tumor that comprises cancer cells with a normal level of surface expressed MHC I. In some embodiments, the cancer cell is in a solid tumor in which 25% or more of the cancer cells have a reduced level of surface expressed MHC I. In some embodiments, the cancer cell is in a solid tumor in which 50% or more of the cancer cells have a reduced level of surface expressed MHC I. In some embodiments, the cancer cell is in a solid tumor in which 75% or more of the cancer cells have a reduced level of surface expressed MHC I. In some embodiments, the cancer cell is in a solid tumor in which 95% or more of the cancer cells have a reduced level of surface expressed MHC I.
In some embodiments, the solid tumor as a whole (e.g., as assessed in a biopsy taken from the solid tumor) has a reduced level of surface expressed MHC I compared to normal cells or tissue from which the solid tumor is derived.
In some embodiments, the RNAs/anti-PD-1 antibody combination provided herein is used in a method of treating an advanced-stage solid tumor cancer.
In some embodiments, the RNAs/anti-PD-1 antibody combination provided herein is used in a method of treating an unresectable solid tumor cancer.
In some embodiments, the RNAs/anti-PD-1 antibody combination provided herein is used in a method of treating a metastatic solid tumor cancer.
In some embodiments, the cytokine RNA mixture is injected into one or more a solid tumor cancer within a lymph node.
In some embodiments, the advanced-stage solid tumor cancer comprises a tumor that is suitable for direct intratumoral injection. In some embodiments, the advanced-stage solid tumor cancer is stage III, subsets of stage III, stage IV, or subsets of stage IV. In some embodiments, the cancer is melanoma. In some embodiments, the melanoma is stage IIIB, stage IIIC, or stage IV. In some embodiments, the cancer is cutaneous squamous cell carcinoma (CSCC). In some embodiments, the cancer is head and neck squamous cell carcinoma (HNSCC). In some embodiments, the CSCC or HNSCC is stage III or stage IV. In some embodiments, the solid tumor cancer is melanoma, optionally wherein the melanoma is uveal melanoma or mucosal melanoma; and comprises superficial, subcutaneous and/or lymph node metastases amenable for intratumoral injection. In some embodiments, the solid tumor cancer is HNSCC and/or mucosal melanoma with only mucosal sites. In some embodiments, the solid tumor cancer is HNSCC. In some embodiments, the solid tumor cancer is uveal melanoma or mucosal melanoma. In some embodiments, the solid tumor cancer is uveal melanoma. In some embodiments, the solid tumor cancer is mucosal melanoma. In some embodiments, the RNAs are injected intratumorally only at mucosal sites of the solid tumor cancer, wherein the solid tumor cancer is HNSCC or mucosal melanoma.
In some embodiments, the subject has failed a prior anti-programmed cell death 1 (PD-1) or anti-programmed cell death 1 ligand (PD-L1) therapy. In other embodiments, the subject has not been treated previously with an anti-PD-1 or anti-PD-L1 therapy. In some embodiments, the subject is without other treatment options.
In some embodiments, the method may comprise reducing the size of a tumor or preventing cancer metastasis in a subject.
In some embodiments, the subject has at least two tumor lesions or at least three tumor lesions. In some embodiments, the subject has two tumor lesions. In some embodiments, the subject has three tumor lesions.
In some embodiments, the subject has measurable disease according to the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria as described herein.
In some embodiments, the subject has a tumor that is suitable for direct intratumoral injection. In some embodiments, whether a tumor is suitable for direct intratumoral injection may be based on the dose volume. In some embodiments, a tumor is suitable for direct intratumoral injection of a cytokine RNA mixture if it includes a cutaneous or subcutaneous lesion ≥0.5 cm in longest diameter or multiple injectable merging lesions which become confluent and have the longest diameter (sum of diameters of all involved target lesions) of ≥0.5 cm suitable for injection (i.e., not bleeding or weeping). In some embodiments, lymph nodes ≥1.5 cm that are suitable for ultrasonography (USG)-guided intratumoral injection and confirmed as metastatic disease are also suitable. In some embodiments, the tumor is uveal melanoma or mucosal melanoma. In some embodiments, the tumor is uveal melanoma or mucosal melanoma; and comprises superficial, subcutaneous and/or lymph node metastases amenable for intratumoral injection.
In some embodiments, the subject is human. In some embodiments, the subject may have a life expectancy of more than 3 months, 4 months, 5 months or 6 months. In some embodiments, the subject has a life expectancy of more than 3 months. In some embodiments, the subject is at least 18 years of age.
In some embodiments, methods for treating an advanced-stage melanoma, cutaneous squamous cell carcinoma (CSCC) or head and neck squamous cell carcinoma (HNSCC) are provided, comprising administering to a subject having an advanced-stage melanoma RNA encoding an IL-12sc protein, RNA encoding an IL-15 sushi protein, RNA encoding an IFNα protein, and RNA encoding a GM-CSF protein and an anti-PD-1 antibody. In some embodiments, (a) the subject is at least 18 years of age; (b) the subject has failed prior anti-PD1 or anti-PD-L1 therapies; (c) the subject has a minimum of 2 lesions; and (d) the melanoma, CSCC, or HNSCC comprises a tumor that is suitable for direct intratumoral injection.
In some embodiments, the subject has measurable disease according to the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria. In some embodiments, the subject has a life expectancy of more than 3 months.
In some embodiments, the solid tumor is an epithelial tumor, prostate tumor, ovarian tumor, renal cell tumor, gastrointestinal tract tumor, hepatic tumor, colorectal tumor, tumor with vasculature, mesothelioma tumor, pancreatic tumor, breast tumor, sarcoma tumor, lung tumor, colon tumor, melanoma tumor, small cell lung tumor, neuroblastoma tumor, testicular tumor, carcinoma tumor, adenocarcinoma tumor, seminoma tumor, retinoblastoma, cutaneous squamous cell carcinoma (CSCC), squamous cell carcinoma for the head and neck (HNSCC), head and neck cancer, or osteosarcoma tumor.
In some embodiments, the solid tumor comprises a primary tumor of any size. In some embodiments, tumor thickness measurements are reported rounded to the nearest 0.1 mm. In some embodiments, the solid tumor comprises a primary tumor having ≤1.0 mm in thickness. In some embodiments, the solid tumor comprises a primary tumor having 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, or 1.0 mm in thickness. In some embodiments, the solid tumor comprises a primary tumor having <0.8 mm (or less than 0.8 mm) in thickness without ulceration. In some embodiments, the solid tumor comprises a primary tumor having ≤0.8 mm (or less than 0.8 mm) in thickness with ulceration. In some embodiments, the solid tumor comprises a primary tumor having from 0.8 to 1.0 mm in thickness. In some embodiments, the solid tumor comprises a primary tumor having 0.8, 0.9, or 1.0 mm in thickness. In some embodiments, the solid tumor comprises a primary tumor having from 0.8 to 1.0 mm in thickness without or with ulceration. In some embodiments, the solid tumor comprises a primary tumor having >1.0-2.0 mm in thickness. In some embodiments, the solid tumor comprises a primary tumor having 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, or 2.0 mm in thickness. In some embodiments, the solid tumor comprises a primary tumor having >1.0-2.0 mm in thickness without or with ulceration. In some embodiments, the solid tumor comprises a primary tumor having >2.0-4.0 mm in thickness. In some embodiments, the solid tumor comprises a primary tumor having 3.0-4.0 mm in thickness. In some embodiments, the solid tumor comprises a primary tumor having 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, or 4.0 mm in thickness. In some embodiments, the solid tumor comprises a primary tumor having >2.0-4.0 mm in thickness without or with ulceration. In some embodiments, the solid tumor comprises a primary tumor having >4.0 mm in thickness. In some embodiments, the solid tumor comprises a primary tumor having 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.8, 4.9, 5.0, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7, 5.8, 5.9, 6.0, 7.0, 8.0, 9.0 or 10.0 mm in thickness. In some embodiments, the solid tumor comprises a primary tumor having >4.0 mm in thickness without or with ulceration. In some embodiments, the thickness is at the thickest (i.e., greatest) dimension of the tumor. In some embodiments, the tumor is a skin cancer tumor and the thickness is from the skin surface to the deepest part of the tumor (e.g., the thickness is not the lateral spread of the tumor). In some embodiments, the tumor is a skin metastasis of a cancer other than a skin cancer, and the thickness of the tumor is from the skin surface to the deepest part of the tumor (e.g., the thickness is not the lateral spread of the tumor).
In some embodiments, the solid tumor is a melanoma solid tumor. In some embodiments, the melanoma comprises a primary tumor of any size. In some embodiments, tumor thickness measurements are reported rounded to the nearest 0.1 mm. In some embodiments, the melanoma comprises a primary tumor having ≤1.0 mm in thickness. In some embodiments, the melanoma comprises a primary tumor having 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, or 1.0 mm in thickness. In some embodiments, the melanoma comprises a primary tumor having <0.8 mm (or less than 0.8 mm) in thickness without ulceration. In some embodiments, the melanoma comprises a primary tumor having ≤0.8 mm (or less than 0.8 mm) in thickness with ulceration. In some embodiments, the melanoma comprises a primary tumor having from 0.8 to 1.0 mm in thickness. In some embodiments, the melanoma comprises a primary tumor having 0.8, 0.9, or 1.0 mm in thickness. In some embodiments, the melanoma comprises a primary tumor having from 0.8 to 1.0 mm in thickness without or with ulceration. In some embodiments, the melanoma comprises a primary tumor having >1.0-2.0 mm in thickness. In some embodiments, the melanoma comprises a primary tumor having 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, or 2.0 mm in thickness. In some embodiments, the melanoma comprises a primary tumor having >1.0-2.0 mm in thickness without or with ulceration. In some embodiments, the melanoma comprises a primary tumor having >2.0-4.0 mm in thickness. In some embodiments, the melanoma comprises a primary tumor having 3.0-4.0 mm in thickness. In some embodiments, the melanoma comprises a primary tumor having 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, or 4.0 mm in thickness. In some embodiments, the melanoma comprises a primary tumor having >2.0-4.0 mm in thickness without or with ulceration. In some embodiments, the melanoma comprises a primary tumor having >4.0 mm in thickness. In some embodiments, the melanoma comprises a primary tumor having 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.8, 4.9, 5.0, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7, 5.8, 5.9, 6.0, 7.0, 8.0, 9.0 or 10.0 mm in thickness. In some embodiments, the melanoma comprises a primary tumor having >4.0 mm in thickness without or with ulceration. In some embodiments, the thickness is from the skin surface to the deepest part of the tumor (the thickness is not the lateral spread of the tumor).
In some embodiments, the melanoma comprises one tumor-involved regional lymph node or any number of in-transit, satellite, and/or microsatellite metastases with no tumor-involved nodes. In some embodiments, the melanoma comprises one clinically occult tumor-involved regional lymph node. In some embodiments, the melanoma comprises one clinically detectable tumor-involved regional lymph node. In some embodiments, the melanoma comprises any number of in-transit, satellite, and/or microsatellite metastases with no tumor-involved nodes. In some embodiments, the melanoma comprises two or three tumor-involved regional lymph nodes or any number of in-transit, satellite, and/or microsatellite metastases with no tumor-involved nodes. In some embodiments, the melanoma comprises two or three clinically occult tumor-involved regional lymph nodes. In some embodiments, the melanoma comprises two or three tumor-involved regional lymph nodes, at least one of which is clinically detectable. In some embodiments, the melanoma comprises two or three tumor-involved regional lymph nodes, one of which is clinically occult or clinically detectable and with presence of in-transit, satellite, and/or microsatellite metastases. In some embodiments, the melanoma comprises any number of in-transit, satellite, and/or microsatellite metastases with one tumor-involved node. In some embodiments, the melanoma comprises four or more tumor-involved regional lymph nodes or any number of in-transit, satellite, and/or microsatellite metastases with two or more tumor-involved nodes or any number of matted nodes without or with in-transit, satellite, and/or microsatellite metastases. In some embodiments, the melanoma comprises four or more clinically occult tumor-involved regional lymph nodes. In some embodiments, the melanoma comprises four or more clinically occult tumor-involved regional lymph nodes, at least one of which is clinically detectable or with presence of any number of matted nodes. In some embodiments, the melanoma comprises two or three tumor-involved regional lymph nodes, one of which is clinically occult or clinically detectable. In some embodiments, the melanoma comprises four or more clinically occult tumor-involved regional lymph nodes, two or more of which are clinically occult or clinically detectable and/or with presence of any number of matted nodes, and with presence of in-transit, satellite, and/or microsatellite metastases.
In some embodiments, the melanoma
In some embodiments, the melanoma has a detectable distant metastasis.
In some embodiments, the melanoma
In some embodiments, the melanoma
In some embodiments, the melanoma
In some embodiments, the melanoma
In some embodiments, the melanoma has no detectable distant metastasis; and comprises
In some embodiments, the melanoma comprises a primary tumor having <0.8 mm or >1.0-2.0 or >2.0-4.0 mm in thickness without ulceration; comprises no detectable distant metastasis; and comprises:
In some embodiments, the melanoma
In some embodiments, the melanoma
In some embodiments, the melanoma
In some embodiments, the cutaneous squamous cell carcinoma (CSCC) or squamous cell carcinoma for the head and neck (HNSCC) comprises a tumor of any size. In some embodiments, the CSCC or HNSCC comprises no identified tumor. In some embodiments, the CSCC or HNSCC comprises a tumor that is 2 cm or smaller in its greatest dimension. In some embodiments, the CSCC or HNSCC comprises a tumor larger than 2 cm but not larger than 4 cm in its greatest dimension. In some embodiments, the CSCC or HNSCC comprises a tumor that is larger than 4 cm in greatest dimension or has minimal erosion of the bone or perineural invasion or deep invasion. In some embodiments, the CSCC or HNSCC comprises a tumor with extensive cortical or medullary bone involvement or invasion of the base of the cranium or invasion through the foramen of the base of the cranium.
In some embodiments, the cutaneous squamous cell carcinoma (CSCC) or squamous cell carcinoma for the head and neck (HNSCC) comprises no regional lymph node metastasis. In some embodiments, the CSCC or HNSCC comprises metastasis in a single ipsilateral lymph node, is 3 cm or smaller in greatest dimension, and is ENE-negative. In some embodiments, the CSCC or HNSCC comprises metastasis in a single ipsilateral lymph node larger than 3 cm but not larger than 6 cm in greatest dimension and ENE-negative. In some embodiments, the CSCC or HNSCC comprises metastases in multiple ipsilateral lymph nodes, none larger than 6 cm in their greatest dimension and is ENE-negative. In some embodiments, the CSCC or HNSCC comprises metastasis in bilateral or contralateral lymph nodes, none larger than 6 cm in greatest dimension, and is ENE-negative. In some embodiments, the CSCC or HNSCC comprises metastasis in a lymph node larger than 6 cm in its greatest dimension and is ENE-negative; or metastasis in any lymph nodes and ENE-negative. In some embodiments, the cutaneous squamous cell carcinoma (CSCC) or squamous cell carcinoma for the head and neck (HNSCC):
In some embodiments, the cutaneous squamous cell carcinoma (CSCC) or squamous cell carcinoma for the head and neck (HNSCC) comprises:
In some embodiments, the cutaneous squamous cell carcinoma (CSCC) or squamous cell carcinoma for the head and neck (HNSCC) comprises:
In some embodiments, the cutaneous squamous cell carcinoma (CSCC) or squamous cell carcinoma for the head and neck (HNSCC)
In some embodiments, the cutaneous squamous cell carcinoma (CSCC) or squamous cell carcinoma for the head and neck (HNSCC)
In some embodiments, the cutaneous squamous cell carcinoma (CSCC) or squamous cell carcinoma for the head and neck (HNSCC)
In some embodiments, the cutaneous squamous cell carcinoma (CSCC) or squamous cell carcinoma for the head and neck (HNSCC)
In some embodiments, the cutaneous squamous cell carcinoma (CSCC) or squamous cell carcinoma for the head and neck (HNSCC)
In some embodiments, the cutaneous squamous cell carcinoma (CSCC) or squamous cell carcinoma for the head and neck (HNSCC) comprises no detectable distant metastasis.
In some embodiments, the therapeutically effective amount of the RNAs results in one or more of: (a) a reduction in the severity or duration of a symptom of cancer; (b) inhibition of tumor growth, or an increase in tumor necrosis, tumor shrinkage and/or tumor disappearance; (c) delay in tumor growth and/or development; (d) inhibited or retarded or stopped tumor metastasis; (e) prevention or delay of recurrence of tumor growth; (f) increase in survival of a subject; and/or (g) a reduction in the use or need for conventional anticancer therapy (e.g., reduced or eliminated use of chemotherapeutic or cytotoxic agents), optionally as compared to an untreated subject or a subject administered only 1, 2, or 3 of the RNAs in the RNA mixture.
This description and exemplary embodiments should not be taken as limiting. For the purposes of this specification and appended claims, unless otherwise indicated, all numbers expressing quantities, percentages, or proportions, and other numerical values used in the specification and claims, are to be understood as being modified in all instances by the term “about,” to the extent they are not already so modified. “About” indicates a degree of variation that does not substantially affect the properties of the described subject matter, e.g., within 10%, 5%, 2%, or 1%. Accordingly, unless indicated to the contrary, the numerical parameters set forth in the following specification and attached claims are approximations that may vary depending upon the desired properties sought to be obtained. At the very least, and not as an attempt to limit the application of the doctrine of equivalents to the scope of the claims, each numerical parameter should at least be construed in light of the number of reported significant digits and by applying ordinary rounding techniques.
It is noted that, as used in this specification and the appended claims, the singular forms “a,” “an,” and “the,” and any singular use of any word, include plural referents unless expressly and unequivocally limited to one referent. As used herein, the term “include”, and its grammatical variants are intended to be non-limiting, such that recitation of items in a list is not to the exclusion of other like items that can be substituted or added to the listed items.
The following examples are provided to illustrate certain disclosed embodiments and are not to be construed as limiting the scope of this disclosure in any way. In the Examples discussed below, the cytokine RNA mixture, as defined above, may be also referred as “the mixture,” “the cytokine mixture,” “the composition,” or “the drug” interchangeably.
Overall design: A first in human, open-label, dose escalation and expansion study for the evaluation of the maximum tolerated and administered doses, safety, tolerability, pharmacokinetics, pharmacodynamics, and anti-tumor activity of the cytokine RNA mixture administered intratumorally as a single agent and in combination with cemiplimab is performed.
Number of participants: Enrollment of up to 72 participants is planned when the cytokine RNA mixture is administered as a single agent, depending on the investigated dose levels during the escalation phase. Enrollment of up to 192 participants is planned, when the cytokine RNA mixture is administered in combination with cemiplimab, depending on the investigated dose levels during the escalation phase and the completed stages for each cohort during the expansion phase. Together, enrollment of up to 264 participants is planned.
Dose escalation phase (monotherapy): There is no formal sample size calculation in the dose escalation phase. The cytokine RNA mixture is administered to patients with advanced solid tumors who have failed a prior anti-PD-1 or anti-PD-L1 based therapy, and/or patients without other treatment options for those indications in which anti-PD-1 is not routinely used. Up to 38 dose limiting toxicities (DLT)-evaluable participants enroll in the dose escalation phase with expected assessment of about 8 dose levels. The actual sample size varies depending on DLTs observed and number of dose levels actually explored.
Dose expansion phase (monotherapy): A Simon's two-stage design is used in the expansion phase and approximately 34 participants with advanced melanoma who failed prior anti-PD-1/anti-PD-L1 therapies enroll. After the first 16 treated participants, there is an interim analysis, and if response is observed in at least 2 participants, accrual continues to the full sample size of 34 participants.
Dose escalation phase (combination therapy): The actual sample size in the dose escalation of the cytokine RNA mixture in combination with cemiplimab varies depending on DLTs observed and number of dose levels actually explored (approximately 18 to 36 DLT-evaluable participants).
Dose expansion phase (combination therapy): A Simon's two stage design is used in expansion phase of the cytokine RNA mixture in combination with cemiplimab and approximately 156 participants with advanced melanoma, CSCC, or HNSCC are enrolled in four cohorts. An interim analysis is performed at the end of Stage 1 of the Simon's two-stage design for each cohort (26 patients for Cohort A, 14 patients for Cohort B, 10 patients for Cohort C, 26 patients for Cohort D). Enrollment in all cohorts (A, B, C, and D) is performed in parallel.
Intervention groups and duration: The duration of the study for a participant includes a period for screening of up to 28 days. Once successfully screened, participants may receive study intervention until disease progression, unacceptable AE, participant's decision to stop the treatment, or for a maximum of 1 year if no disease progression occurs. Continuation of the cytokine RNA mixture as a single agent and in combination with cemiplimab will be considered beyond 1 year by the study committee on a case by case basis for those participants that clearly continue to derive clinical benefit in a safe manner with reasonable toxicity. After discontinuing study intervention, participants return to the study site approximately 30 days after the last IMP administration or before the participant receives another anticancer therapy, whichever is earlier, for end-of-treatment assessments. If the participant discontinues study intervention for reasons other than progression, follow-up visits are performed every 3 months until disease progression, initiation of another anticancer treatment, or death (whichever comes first).
The expected duration of treatment for participants who benefit from the cytokine RNA mixture and/or cemiplimab may vary, based on progression date; but median expected duration of study per participant is estimated as 9 months (1 month for screening, 5 months for treatment, and 3 months for end of treatment follow-up) and 12 months in combination therapy (1 month for screening, 8 months for treatment, and 3 months for end of treatment follow-up).
In monotherapy, the cytokine RNA mixture is administered intratumorally once per week in a 4-week cycle (i.e., four doses every 28 days). In the combination therapy, the cytokine RNA mixture is administered intratumorally once per week with cemiplimab administered intravenously on Day 1 of a 3-week cycle (i.e., three doses of the cytokine RNA mixture and one dose of cemiplimab every 21 days). Intratumoral injection is to continue weekly until the second tumor assessment, at which time a change of the dose interval of the cytokine RNA mixture to twice or once a month (in monotherapy) or every three weeks (in combination therapy) may be considered; a more flexible dose interval of the cytokine RNA mixture administration may also be considered depending on available data.
Advancement to higher dose levels during the escalation phase in monotherapy and in combination therapy occurs based on toxicity; intermediate doses may also be considered. In monotherapy, once early efficacy signals are seen at a dose level that is declared safe, it may be expanded to confirm the efficacy.
Dose omissions or dose delay may occur throughout the study; the occurrence of dose limiting toxicities (DLTs) determines the need for these modifications. Participants who experience a DLT have their treatment stopped (in either monotherapy or combination therapy), and are followed until resolution to Grade 1 or baseline status. The study intervention is definitively discontinued in case a DLT is observed during the DLT observation period. If an AE meets the DLT criteria and occurs after the DLT observation period, a benefit-risk assessment is made on a case by case basis to decide whether to continue therapy. After recovery from dose omission of the cytokine RNA mixture that does not exceed two weeks (i.e., 2 dose omissions), the participant may resume therapy with a new cycle of treatment at the same or a lower dose level; no dose re-escalation is allowed for such re-dosed participants at a lower dose level. If the participant experiences the same AE leading to a second dose omission for 2 weeks (i.e., 2 dose omissions), then the participant may be permanently discontinued. Participants receiving cemiplimab remain on the assigned dosage throughout the course of study treatment (350 mg Q3W), and no dose modifications are allowed for cemiplimab if not considered as a mandatory requirement due to safety profile; however, treatment cycle delay or an omission of cemiplimab dose are permitted if needed due to toxicity. If a participant has a cemiplimab infusion-related allergic drug reaction that leads to the termination of cemiplimab treatment, the participant may continue the cytokine RNA mixture treatment at the assigned dose level as monotherapy.
Investigational medicinal product: the cytokine RNA mixture
Investigational medicinal product: cemiplimab
For the combination cohorts, cemiplimab is administered intravenously at the fixed recommended dose of 350 mg Q3W, followed by the cytokine RNA mixture administered intratumorally weekly. On days of treatment with both cemiplimab and the cytokine RNA mixture, cemiplimab is administered first followed by the cytokine RNA mixture (on the same day).
Noninvestigational medicinal products(s): No pre-defined premedication is administered.
Post-trial access to study medication: All participants enrolled to this study are treated for 1 year or until disease progression, whichever is the earliest.
Statistical considerations: Data from monotherapy and combination therapy are analyzed separately. Separate analyses are done for each cohort in combination therapy during dose expansion.
a. Primary Analysis:
Dose escalation (monotherapy and combination therapy): In the dose escalation phase, DLTs are summarized by dose level. Details of DLTs are provided by participant. The treatment-emergent AEs/SAEs and laboratory abnormalities during the on-treatment period are summarized using descriptive statistics by dose level.
Dose expansion (monotherapy and combination therapy): Objective response rate (ORR) per RECIST 1.1 are summarized with descriptive statistics. A 90% two-sided confidence interval is computed using Clopper-Pearson method. The statistical inference is based on the hypothesis and alpha level defined in the sample size calculation section.
b. Analysis of Secondary Endpoints:
Dose escalation (monotherapy and combination therapy): Concentration and PK parameters of the cytokines encoded by the cytokine RNA mixture and of cemiplimab are summarized with descriptive statistics during cycles in which PK is assessed. Anti-drug antibodies (ADAs) against the cytokines encoded by the cytokine RNA mixture and ADAs against cemiplimab are descriptively summarized.
Dose expansion (monotherapy and combination therapy): The treatment-emergent AEs/SAEs and laboratory abnormalities during the on-treatment period are summarized using descriptive statistics. DoR and PFS per RECIST 1.1 and iRECIST are summarized using the Kaplan-Meier method. A similar analysis as ORR per RECIST 1.1 is provided for DCR per RECIST 1.1 and iRECIST, and the ORR per iRECIST. PK concentration and parameters of the cytokines encoded by the cytokine mixture and of cemiplimab are summarized with descriptive statistics during cycles in which PK is assessed. ADAs against the cytokines encoded by the cytokine RNA mixture and ADAs against cemiplimab are descriptively summarized.
The dose escalation phase in monotherapy aims to determine the MTD or MAD of the cytokine RNA mixture administered weekly as monotherapy. (
The dose escalation phase in combination therapy aims to determine the MTD or MAD of the cytokine RNA mixture administered weekly in combination with cemiplimab administered IV once every 3 weeks. The dose escalation of the cytokine RNA mixture in combination with cemiplimab is initiated during the ongoing monotherapy dose escalation, once a dose level has been demonstrated to be safe and tolerable in monotherapy (based on a 28-day DLT observation period); once signs of PK, PDy, and/or clinical response (systemic and/or local) have been shown. After beginning the combination escalation phase, the DLs explored in combination are the same as in monotherapy. If the site participates in both of the dose escalation phases (i.e., dose escalation in both monotherapy and combination therapy parts of the study), the dose escalation phase in the monotherapy part of the study is prioritized. (
Tables 2 and 3 show the Schedule of Activities (SOA) for monotherapy with Table 2 showing the treatment flowchart and Table 3 showing the PK and PDy flowchart for the dose escalation and expansion phases. Tables 4 and 5 show the Schedule of Activities (SOA) for combination therapy with Table 4 showing the treatment flowchart and Table 5 showing the PK and PDy flowchart for the dose escalation and expansion phases.
a Evaluation: Assessments are performed prior to administration of study drug unless otherwise indicated. Results are reviewed by the investigator prior to the administration of the next dose. Tumor biopsy is collected for immunohistochemistry, genomic, RNA-sequencing, and neo-antigen analyses
b A cycle is 28 days, with the cytokine RNA mixture administered intratumorally every week as monotherapy.
c Demography: Includes age, gender, race, and ethnicity. Medical/Surgical History: Includes relevent history of previous pathologies and surgeries. Disease History: Includes stage at diagnosis and at study entry, and previous anti-tumor therapy (type, duration, reason for discontinuation and response to the therapy). In addition, specific mutations depending on tumor type.
d Body weight is measured prior to treatment on the first day of each cycle.
e Height is measured during baseline only.
f Vital signs include: temperature, blood pressure, heart rate, respiration rate. Vital signs must be checked every 6 hours during each 24 hour inpatient hospitalization period during C1D1 at each new dose level while participants are monitored to assess for acute toxicities.
gPhysical examination includes examination of major body systems including cardiovascular system, digestive system, central nervous system, respiratory system, and hematopoietic system (hepatomegaly, splenomegaly, lymphadenopathy), and skin. Signs and symptoms are reported in the eCRF as AEs only if they are still present at the time of first IMP administration.
hGiven that a modest pharmacological effect (e.g., redness, edema or flattening of a cytokine RNA mixture injected tumor lesion) is expected to occur following DL3, color digital photographs are mandatory starting at DL4 of mono escalation, starting from first DL in combo escalation and during expansion phase. Digital photographs are mandatory at screening prior to first dose of cytokine RNA mixture and at the time of radiographic tumor assessment from superficial and/or visible subcutaneous injected lesions to document overall disease status and to document responses. In addition, ad hoc color digital photographs must be taken in between screening and tumor assessment windows to capture other cytokine RNA mixture potentially induced changes such as skin redness and/or edema. All collected by the clinical site must be systematically shared with the Sponsor for review as per study reference manual
iSerum pregnancy testing is performed for women of child bearing potential. A seven-day window is acceptable at baseline assessment.
j Blood hematology: Hemoglobin, hematocrit, WBC with differential (including absolute neutrophil count [ANC]), platelet count. These tests are done before each IMP administration (−1 day window is acceptable). If Gmde 4 neutropenia, assess ANC every 2-3 days until ANC ≥0.5 × 109/L, then weekly until recovery. The Cycle 1 Day 1 assessment is done within 2 days of IMP administration, if abnormal at baseline.
kCoagulation: activated partial thromboplastin time (aPTT), PT, international normalized ration (INR), fibrinogen (and D-dimer at Screening). The Cycle 1 Day 1 assessment is done within 2 days of IMP administration, if abnormal at baseline.
lSerum chemistry: Liver function tests: AST, ALT, total bilirubin, direct bilirubin, alkaline phosphatase (ALP). Renal function tests: Urea or BUN & creatinine, and determination of estimated CrCL when required (if creatinine between 1.0 and 1.5x ULN). Electrolytes: Sodium, potassium, total calcium, phosphorus, chloride, magnesium and bicarbonate. Others: glucose, lactate dehydrogenase (LDH), albumin, total proteins, and amylase. The liver function tests, renal function tests, electrolytes, glucose, LDH, albumin and total proteins are performed before IMP administration (−1 day window is acceptable), unless clinically indicated. In case of Grade ≥3 liver function abnormal tests, additional tests are repeated every 2-3 days until recovery to baseline value. The Cycle 1 Day 1 serum chemistry assessment is done within 2 days of IMP administration, if abnormal at baseline.
mSerum C-reactive protein (CRP), ferritin, and secondary plasma cytokines (including interleukin-6 and interferon-alpha) are be collected at the specified time points and in case of occurrence of CRS Grade ≥2 symptoms. Serum CRP and Ferritin samples are collected just before each study intervention (D1) and at 24 hr (D2) during Cycle 1 appearance of Grade ≥2 symptoms of CRS. Routine sampling of secondary plasma cytokines occurs only in Cycles 1 and 3, and at EOT. Samples are collected at pre-dose and 6 and 24 hours after the cytokine RNA mixture administration at Cycle 1, Weeks 1 and 2, and Cycle 3 Week 1; at EOT; and in case of Grade ≥2 symptoms of CRS.
n12-lead ECG: to be done at screening and pretreatment at Cycle 1 Day 1, Cycle 3 Day 1, Cycle 7 Day 1, and EOT, and when clinically indicated.
oBone marrow aspirate: Only for patient with lymphoma.
pFDG-PET-CT/CT: FDG PET only applicable for patients with lymphoma as per Lugano classification to be performed within 28 days of IMP administration (−7 days), and approximately every 12 weeks (±7 days) to confirm CR and PD and as clinically indicated.
q Urinalysis: Dipstick (qualitative) tests on morning spot by dipstick are performed at baseline and before each IMP administration and at EOT. Quantitative urinalysis for leukocytes and red blood cells on morning spot urine are performed at baseline, at uneven cycles, at the end of treatment, and in case of abnormality in the dipstick test (qualitative). In case of proteinuria ≥++ (dipstick), proteinuria quantification by proteinuria/24 hr urine collection is performed.
rUrine biomarker: kidney injury molecule-1 (KIM-1), urinary microalbumin, and urinary creatinine (in spot urine) are assessed at pre-dose on Cycle 1 Day 1 (within 7 days beforehand is acceptable), 24 hr after the first IMP administration, and pre-dose on day 8 after the first IMP administration.
sOphthalmologic exam including Schirmer's test is performed at baseline and in case of ocular symptoms during therapy. Ocular and visual symptoms are assessed on Day 1 of each Cycle.
tAdverse Event assessment: The period of observation for collection of adverse events extends from the signature of the Informed Consent Form (ICF) until 30 days after the last administration of the study drug. Serious adverse events are assessed and reported as described in the protocol. After the EOT visit, ongoing SAEs and AESIs, related AEs, and new related AEs are to be followed up to stabilization, recovery, or initiation of further therapy.
uConcomitant Medication assessment: Concomitant medications are recorded from 14 days prior to the initial dose of study drug until 30 days after the last administration of study drug, resolution of ongoing study-drug related adverse events, or when another anticancer therapy is received.
vStudy drug administration: Participants may receive premedication(s) as specified herein. At each new dose level at Cycle 1 and Day 1, participants are monitored for at least 24 hr in the hospital to assess acute toxicities. With subsequent administrations, participants undergo observation for 4-6 hrs with optional hospitalization up to 24 hr at Investigator discretion. Cytokine RNA mixture can be administered with a window of +/− 1 days during Cycle 1 and with a window of +/− 3 days starting from Cycle 2.
wTumor assessment: CT-scan or magnetic resonance imaging (MRI) and any other exams as clinically indicated are performed to assess disease status at baseline (within 28 days of IMP administration +/− 7 days), every 8 weeks following IMP administration (−/+ 7 days) up to Week 24, then every 12 weeks (−/+ 7 days) and at the end of study intervention, except if already done at last cycle. Patients who discontinued study intervention without progressive disease are followed every 12 weeks until the documented progressive disease. Tumor assessment is repeated to confirm a partial or complete response as well as progressive disease (at least 4 weeks after initial documented response). For participants who do not have visceral / deep lymphatic lesions, radiological tumor assessment of abdomen and thorax are performed at 24 weeks, if there is no clinical sign of metastatic disease, and at EOT if not already done at last cycle. Intermittent ultrasonography (USG) or clinically indicated assessment can be considered in case of clinical signs or laboratory abnormalities, mainly liver function tests, to exclude potential metastatic disease.
x End of treatment (30 ± 5 days after last treatment): Obtain end of treatment assessments if not performed during the last week of the study.
y Post-study follow-up for disease status: Participants without documented disease progression at the end of a treatment visit who have not yet started treatment with another anticancer therapy proceed with 3 months follow-up visits until initiation of another anticancer therapy, disease progression, death, or study cutoff date (whichever comes first).
aBlood samples for PK are collected for evaluation of target expression of the cytokine RNA mixture - encoded cytokines in all enrolled participants on Cycle 1 Week 1 at pre-dose and 1, 2, 6, 24, 48, and 96 or 120 hours after IMP administration. At Cycle 1 Week 2 in the dose escalation phase, samples are collected at pre-dose and 2, 6, 24, and 48 hours post dosing; in the dose expansion phase, Cycle 1 Week 2 sampling occurs only at pre-dose, 6, and 24 hours post dosing. At Cycle 1 Week 3 and subsequent Cycles, see footnoteb. Samples are also collected right before the tumor biopsy, at EOT and the first follow up visit. Further information is detailed in the study laboratory manual. No PK samples are collected following the second study cut-off date (see herein).
bFor PK, for Cycle 3 Week 1 (ie, week 9 from first administration), the schedule for Cycle 1 Week 1 is repeated. Beyond Cycle 3, PK sampling is to occur at 0 and 6 hours at Week 1 of every odd-numbered cycle. Beyond Cycle 3, PK samples of odd-numbered cycles can be omitted by notification of the Sponsor, if available data are considered sufficient.
cBlood sample for immune assessment and circulating factors: Blood samples are collected at pre-dose, 6, and 24 hr of Cycle 1 Weeks 1 and 2, at EOT, and FU in all participants to assess systemic immune modulations including IFNγ and IP10. Further information us be detailed in the study laboratory manual.
dIn Cycle 3 Week 1 only, the sampling schedule for Cycle 1 Week 1 is repeated for immune assessment and circulating factors. Beyond Cycle 3, PDy sampling is to occur at 0 and 6 hrs at Week 1 of every odd-numbered Cycle. No sampling of blood for PDy cytokines occurs during even-numbered cycles during the monotherapy part of the study.
eBlood for genetic analysis is used to establish the germline DNA sequence and HLA typing.
fBlood samples (leukapheresis or 80 mL of blood) are collected pre-dose Cycle 1 Week 1, pre-dose Cycle 2 Week 2 (ie, 5 weeks post-dose on Cycle 1), and at EOT for the analysis of antigen specific T-cell. This analysis will occur only for participants with melanoma in the monotherapy escalation phase and for all participants (melanoma) in the monotherapy expansion phase.
gTumor biopsy for immune assessment: biopsies are collected during the screening period (before IMP administration on Cycle 1 Day 1), between Weeks 5 and 8, and at Cycle 6 or at disease progression (whichever occurs first), to assess immune modulations. Tumor transcriptomics (RNA sequencing), genomics, neo-antigens, and TIL isolation (expansion only in melanoma patients) may also be performed upon sample availability (see herein). For melanoma patients only, a single tumor core biopsy performed between Weeks 5-8 is dedicated for TILs isolation. This is applied to a limited number (aiming no more than 10 patients with successful TILs isolation) of selected melanoma patients (expansion for monotherapy and only in Cohort A of combination therapy expansion). This will not be an additional biopsy, but instead the sample dedicated for genomic assessment will be used for TILs isolation (handled under special conditions-not formalin fixed). This kind of sample and testing is applied to patients with clinical signs of response to treatment (tumor size reduction and/or redness at the tumor site) as determined by the treating investigator.
h Plasma samples to monitor development of antibodies to the cytokine RNA mixture - encoded cytokines are collected pre-dose Day 1 for Cycles 1, 3, 6, 9, 12 and/or EOT, and at FU (Day 90 after last IMP administration). Additional collections beyond these timepoints are every 3 months if the participant continues on study for follow-up visits. No ADA samples are collected following the second cut-off date.
aEvaluation: Assessments are performed prior to administration of study drug unless otherwise indicated. Results are reviewed by the investigator prior to the administration of the next dose. Tumor biopsy are collected for immunohistochemistry, genomic, RNA-sequencing, and neo-antigen analyses.
bIn combination with Cemiplimab a cycle is 21 days, with the cytokine RNA mixture administered intratumorally weekly and Cemiplimab administered at the fixed dose of 350 mg intravenously once every 3 weeks.
cDemography: Includes age, gender, and race. Medical/Surgical History: Includes relevant history of previous pathologies and surgeries. Disease History: Includes stage at diagnosis and at study entry, and previous anti-tumor therapy (type, duration, reason for discontinuation and response to the therapy). In addition, specific mutations depending on tumor type.
dBody weight is measured prior to treatment on the first day of each cycle.
eHeight is measured during baseline only.
fVital signs include: temperature, blood pressure, heart rate, respiration rate. In addition, pulse oximetry is assessed at baseline for participants in the combination therapy part of the study. Vital signs are checked every 6 hours during each 24 hour inpatient hospitalization period, during C1D1, at each new dose level while participants are monitored to assess for acute toxicities. Pulse oximetry is not required during 24 hour inpatient hospitalization period.
gPhysical examination includes: examination of major body systems including cardiovascular system, digestive system, central nervous system, respiratory system, hematopoietic system (hepatomegaly, splenomegaly, lymphadenopathy), and skin. Signs and symptoms are reported in the eCRF as AEs only if they are still present at the time of first IMP administration
hGiven that a modest pharmacological effect (e.g., redness, edema or flattening of a cytokine RNA mixture injected tumor lesion) is expected to occur following DL3, color digital photographs are mandatory starting at DL4 of mono escalation, starting from first DL in combo escalation and during expansion phase. Digital photographs are mandatory at screening prior to first dose of cytokine RNA mixture and at the time of radiographic tumor assessment from superficial and/or visible subcutaneous injected lesions to document overall disease status and to document responses. In addition, ad hoc color digital photographs are taken in between screening and tumor assessment windows to capture other cytokine RNA mixture potentially induced changes such as skin redness and or edema. All collected by the clinical site are systematically shared with the Sponsor for review as per study reference manual.
iSerum pregnancy testing is performed for women of child bearing potential. A seven-day window is acceptable at baseline assessment.
jBlood hematology: Hemoglobin, hematocrit, WBC with differential (including absolute neutrophil count [ANC]), platelet count. These tests are done before each IMP administration (−1 day window is acceptable). If Grade 4 neutropenia, assess ANC every 2-3 days until ANC ≥0.5 × 109/L, then weekly until recovery. The Cycle 1 Day 1 assessment is done within 2 days of IMP administration, if abnormal at baseline.
kCoagulation (−1 day window is acceptable): activated partial thromboplastin time (aPTT), PT, international normalized ration (INR), fibrinogen (and D-dimer at Screening). The Cycle 1 Day 1 assessment is done within 2 days of IMP administration, if abnormal at baseline.
lSerum chemistry (−1 day window is acceptable): Liver function tests: AST, ALT, total bilirubin, direct bilirubin, alkaline phosphatase (ALP). Renal function tests: Urea or BUN & creatinine, and determination of estimated CrCL when required (if creatinine between 1.0 and 1.5 × ULN). Electrolytes: Sodium, potassium, total calcium, phosphorus, chloride, magnesium, bicarbonate and uric acid. Others: glucose, lactate dehydrogenase (LDH), albumin, total proteins, and amylase. The liver function tests, renal function tests, electrolytes, glucose, LDH, albumin and total proteins are performed before IMP administration (−1 day window is acceptable), unless clinically indicated. In case of Grade ≥3 liver function abnormal tests, additional tests are repeated every 2-3 days until recovery to baseline value. The Cycle 1 Day 1 serum chemistry assessment is done within 2 days of IMP administration, if abnormal at baseline.
mThyroid-stimulating hormone (TSH), free thyroxine (free T4) anti-nuclear antibodies (ANA), and rheumatoid factor (RF) are assessed for safety with cemiplimab administration
nTumor mutation burden (TMB) is assessed at baseline only for participants in the combination therapy portion of the study.
oSerum C-reactive protein (CRP), ferritin, and secondary plasma cytokines (including interleukin-6 and interferon-γ; see herein) are collected at the specified time points and in case of occurrence of CRS Grade ≥2 symptoms. Serum CRP and Ferritin samples are collected just before each study intervention (D1) and at 24 hr (D2) during Cycle 1 (for each Week, 1-3) and during Cycle 3 Week 1. On other study intervention days, only pre-dose samples are collected; additional samples is withdrawn whenever the appearance of Grade ≥2 symptoms of CRS. Routine sampling of secondary plasma cytokines occurs only in Cycles 1 and 3, and at EOT. Samples are collected at pre-dose and 6 and 24 hours after the cytokine RNA mixture administration at Cycle 1, Weeks 1 and 2, and Cycle 3 Week 1; at EOT; and in case of Grade ≥2 symptoms of CRS.
p12-lead ECG: to be done at screening and pretreatment at Cycle 1 Day 1, Cycle 3 Day 1, Cycle 7 Day 1, and EOT, and when clinically indicated. Echocardiogram or MUGA scan is done only at screening.
qDiffusing capacity of the lungs for carbon monoxide (DLCO) is performed at baseline for participants with lymphoma previously treated with bleomycin.
rBone marrow aspirate: Only for patient with lymphoma
sFDG-PET-CT/CT: FDG PET only applicable for patients with lymphoma as per Lugano classification to be performed within 28 days of IMP administration (−7 days), and approximately every 12 weeks (±7 days) to confirm CR and PD and as clinically indicated.
tUrinalysis: Dipstick (qualitative) tests on morning spot by dipstick are performed at baseline and before each IMP administration and at EOT. Quantitative urinalysis for leukocytes and red blood cells on morning spot urine is performed at baseline, at uneven cycles, at the end of treatment, and in case of abnormality in the dipstick test (qualitative). In case of proteinuria >++ (dipstick), proteinuria quantification by proteinuria/24 hr urine collection is performed.
uUrine biomarker: kidney injury molecule-1 (KIM-1), urinary microalbumin, and urinary creatinine (in spot urine) are assessed at pre-dose on Cycle 1 Day 1 (within 7 days beforehand is acceptable), 24 hr after the first IMP administration, and pre-dose on day 8 after the first IMP administration.
vOphthalmologic exam including Schirmer's test is performed at baseline and in case of ocular symptoms during therapy. Ocular and visual symptoms is assessed on Day 1 of each Cycle.
wAdverse Event assessment: The period of observation for collection of adverse events extends from the signature of the Informed Consent Form (ICF) until 30 days after the last administration of the study drug. Serious adverse events is assessed and reported as described in the protocol. After EOT visit, ongoing SAEs, and AESIs, related AEs, and new related AEs are to be followed up to stabilization, recovery, or initiation of further therapy. Following end of treatment (EOT) with the cytokine RNA mixture + cemiplimab, trial participants that have not yet enrolled into subsequent clinical trials with another IMP or have received any other standard of care therapy undergo continuous monitoring every 2 weeks for kidney injury with the following study procedures: Renal function tests [Urea or BUN & creatinine, and determination of estimated Cr CL when required (if creatinine between 1.0 and 1.5x ULN)], Urinalysis (Quantitative urinalysis for leukocytes and red blood cells on morning spot uring are performed in case of abnormality in the qualitative dipstick test. In case of proteinuria ≥++ (dipstick), proteinuria quantification by proteinuria/24 hr urine collection is performed and urinary Biomarkers (kidney injury molecule-1 (KIM-1), urine albumin-to-creatinine ratio) following pre-dose day 8 testing after the first IMP administration.
xConcomitant Medication assessment: Concomitant medications are recorded from 14 days prior to the initial dose of study drug until 30 days after the last administration of study drug, resolution of ongoing study-drug related adverse events, or when another anticancer therapy is received.
yThe cytokine RNA mixture administration: Participants may receive premedication(s) as specified in study protocol. At each new dose level at Cycle 1 and Day 1, participants are monitored for at least 24 hr in the hospital to assess acute toxicities. With subsequent administrations, participants undergo observation for 4-6 hrs with optional hospitalization up to 24 hr at Investigator discretion. On co-administration days, the cytokine RNA mixture is administered after completion administration. The cytokine RNA mixture can be administered with a window of ±1 days during Cycle 1 and with a window of ±3 days starting from Cycle 2.
zCemiplimab is administered in combination with the cytokine RNA mixture in the combination therapy part of the study in a 3 weeks cycle. Cemiplimab is to be administered before the cytokine RNA mixture, as stated in footnote.
aaTumor assessment: CT-scan or magnetic resonance imaging (MRI) and any other exams as clinically indicated are performed to assess disease status at baseline (within 28 days of IMP administration −7 days), every 9 weeks following IMP administration (±7 days) up to Week 24, then every 12 weeks (±7 days) and at the end of study intervention, except if already done at last cycle. Patients who discontinued study intervention without progressive disease are followed every 12 weeks until the documented progressive disease. Tumor assessment is repeated to confirm a partial or complete response as well as progressive disease (at least 4 weeks after initial documented response). For participants who do not have visceral / deep lymphatic lesions, radiological tumor assessment of abdomen and thorax is performed at 24 weeks, if there is no clinical sign of metastatic disease, and at EOT if not already done at last cycle. Intermittent ultrasonography (USG) or clinically indicated assessment can be considered in case of clinical signs or laboratory abnormalities, mainly liver function tests, to exclude potential metastatic disease.
bbEnd of treatment (30 ± 5 days after last treatment): Obtain end of treatment assessments if not performed during the last week of the study.
ccPost-study follow-up for disease status: Participants without documented disease progression at the end of a treatment visit who have not yet started treatment with another anticancer therapy proceed with 3 months follow-up visits until initiation of another anticancer therapy, disease progression, death, or study cut-off date (whichever comes first).
aThe cytokine RNA mixture is administered weekly in 3-week cycles. Cemiplimab is administered in combination with the cytokine RNA mixture in the combination therapy part of the study in 3-week cycles (ie, administration days of cemiplimab are Cycle 1 Day 1, Cycle 2 Day 1, and subsequent). On co-administration days, cemiplimab is to be administered intravenously first, followed by the cytokine RNA mixture intratumorally.
bFor cytokine RNA mixture PK, in the combination therapy escalation phase all participants undergo dense sampling. In expansion phase cohorts A, B, C, and D only the first 10 participants of each cohort undergo dense sampling (see herein), (the remainder participants in expansion phase undergo sparse sampling). Beyond Cycle 3, PK sampling is to occur at 0 and 6 hours at Week 1 of every odd-numbered cycle; and between Week 5 and 8 following the first administration and at Cycle 6, PK sampling occurs right before tumor biopsy. No sampling occurs during other cycles. Samples are also collected at EOT and at the first follow-up visit. Further information is detailed in the study laboratory manual. No PK samples are collected following the second study cut-off date.
cFor the cytokine RNA mixture PK, sparse sampling occurs only for the participants that follow the first 10 participants in combination therapy expansion phase cohorts A, B, C and D. Beyond Cycle 3, PK sampling is to occur at 0 and 6 hours at Week 1 of every odd-numbered cycle; and between Weeks 5 and 8 after the first administration and at Cycle 6, PK sampling occurs right before the tumor biopsy. No sampling occurs during other cycles. Samples are also collected at EOT and at the first follow-up visit. No PK samples are collected following the second study cut-off date.
dIf the participant is in the dense sampling PK subset, the schedule for dense sampling is followed; if the participant is not part of the dense sampling subset, the schedule for sparse sampling is followed. Cemiplimab PK in the combination therapy study portion is measured at Cycle 1 Week 1, Cycle 2 Week 1, and for all subsequent odd-numbered Cycles. During Cycle 3, blood for cemiplimab is collected at SOI and EOI only. For all SOI samples, the cemiplimab PK sample is collected strictly before (within 15 minutes of) the start of the cemiplimab infusion. For all EOI samples, the blood for cemiplimab is to be collected just before (within 5 minutes of) the actual end of cemiplimab infusion.
eThe Cycle 2 Day 1 pre-infusion blood for cemiplimab sample (0 H) is collected even if the second infusion of cemiplimab is not administered in case the patient withdraws from the study at the end of Cycle 1.
fBlood sample for immune assessment and circulating factors: Blood samples are collected at pre-dose, 6, and 24 hr of Cycle 1 Weeks 1 and 2, at EOT, and FU in all participants to assess systemic immune modulations including IFNγ and IP10. Further information is detailed in the study laboratory manual.
gIn Cycle 3 Week 1 only, the sample schedule for Cycle 1 Week 1 is repeated for immune assessment and circulating factors. Beyond Cycle 3, PDy sampling is to occur at 0 and 6 hrs at Week 1 of every odd-numbered Cycle. Blood for PDy cytokines samples are not collected during Cycle 2 or any even-numbered Cycle.
hBlood for genetic analysis is used to establish the germline DNA sequence and HLA typing.
iTumor biopsy for immune assessment: paired tumor biopsies is collected during the screening period (before IMP administration on Cycle 1 Day 1), between Weeks 5 and 8, and at Cycle 6 or at disease progression (whichever occurs first), to assess immune modulation. Tumor transcriptomics (RNA sequencing), genomics neo-antigens, and TIL isolation may also be performed upon sample availability. For melanoma patients only, during expansion, a single tumor core biopsy performed between Weeks 5-8 is dedicated for TILs isolation. This is applied to a limited number of selected melanoma patients (aiming no more than 10 patients with successful TILs isolation). This is not an additional biopsy, but instead the sample dedicated for genomic assessment is used for TILs isolation (handled under special conditions-not formalin fixed). This kind of sample and testing is applied to patients with clinical signs of response to treatment (tumor size reduction and/or redness at the tumor site) as determined by the treating investigator. Tumor biopsy is mandatory for all participants, depending on tumor availability and medical feasibility. Further information is provided in the Study Manual.
jBlood samples (leukapheresis or 80 mL of blood) are collected in Cohort A (melanoma PD-1/PD-L1 refractory) only at expansion phase at pre-dose Cycle 1 Week 1, pre-dose Cycle 2 Week 3, 5 weeks post initial administration in Cycle 1 Week 1, and at EOT for the analysis of antigen specific T-cell.
kBlood sampling for RNAseq: peripheral blood is used to extract RNA for testing.
lSamples to monitor development of ADAs to the cytokine RNA mixture-encoded cytokines are collected pre-infusion for Cycles 1, 5, 9, 13, 17 and/or EOT, and at Day 90 after last IMP administration. Additional collections beyond these timepoints are every 3 months if the participant continues on study for follow-up visits. No ADA samples are collected following the second cut-off date.
mSamples to monitor development of antibodies to cemiplimab are collected pre-infusion for Cycle 1 (baseline) and pre-infusion for Cycles 5, 9, 13, 17, EOT, and FU. ADA samples are stored and may be analyzed by the end of the study. In the case of occurrence of an immune-related adverse event, hypersensitivity reaction requiring immediate treatment, and/or anaphylaxis in a participant, blood samples are collected, if possible, at or near the onset and completion of the event for the analysis of functional cemiplimab concentrations in serum and ADA assessments for cemiplimab.
Objectives and endpoints for the treatment are shown in Table 6.
A dose escalation and dose expansion study of the cytokine RNA mixture is performed in patients with advanced solid tumors in escalation phase and advanced melanoma in expansion phase, based on clinical, pharmacokinetic [PK], pharmacodynamic [PDy], and biomarker evaluations, to assess the safety and preliminary activity of the cytokine RNA mixture when administered intratumorally as monotherapy and in combination with cemiplimab, and to define the optimal dose of drug as a single agent and in combination with cemiplimab.
Screening occurs for up to 28 days before participants receive their first dose of the cytokine RNA mixture, and evaluations occur on a schedule with drug administration intratumorally at days 1, 8, 15, and 22 of a 4-week cycle, and weekly in a 3-week cycle in combination with cemiplimab (cemiplimab to be administered every 3 weeks). In monotherapy and combination, treatment is continued until disease progression or AE leading to permanent discontinuation; otherwise it is continued up to 1 year of treatment (13 cycles for monotherapy and 17 cycles for combination therapy). In the combination therapy escalation and expansion phases, cemiplimab is administered intravenously at the fixed recommended dose of 350 mg Q3W, in combination with the cytokine RNA mixture administered intratumorally weekly at a pre-defined dose. In combination therapy, the cytokine RNA mixture will be administered at the end of the cemiplimab infusion. In the monotherapy escalation phase, a single-participant dose escalation for the first two dose levels (DLs) is used in the escalation phase, followed by escalation to higher doses using a rational design.
During dose escalation in monotherapy and in combination with cemiplimab, participants with advanced solid tumors amenable for intratumoral injection who failed a prior therapy based on anti-PD-1/PD-L1 are enrolled. Participants with solid tumors (other than melanoma), for which anti-PD-1/PD-L1 therapy is not routinely used, are also eligible if there are no other suitable treatment options, based on the discretion of the Investigator. Participants are treated with intratumoral injection of the cytokine RNA mixture administered weekly as monotherapy or in combination with cemiplimab.
In monotherapy, the starting dose level (DL1) is determined from the results of various preclinical studies examining the PK of cytokines encoded by the cytokine RNA mixture in human xenograft models, and allometric scaling from mouse to human using modeling and simulation.
The experiments include an accelerated dose escalation design for the first two DLs (DL1 and DL2), where one participant is treated by DL and an escalation between two dose levels is applied until observation of any IMP-related Grade ≥2 AE or dose limiting toxicity (DLT). If an IMP-related Grade ≥2 AE is observed at either of the first two DLs, two additional participants are treated at the same DL and dose escalation proceeds using an adaptive rational design. If no IMP-related Grade ≥2 AE or DLT occurs in the first 2 DLs, then an adaptive dose escalation starts from DL3. Dose escalation for subsequent cohorts (DL3-DL8) proceeds. Enrollment to the next DL does not proceed before at least three participants treated at the previous DL have been followed for a duration of at least 1 cycle (i.e., 28 days), and are evaluable for DLT assessment with no DLT. No intra-participant dose escalation is allowed.
Once early efficacy signals are seen at a DL that is declared as safe, it can be further expanded to confirm the efficacy. The dose escalation continues in parallel to the lower level dose expansion.
In combination therapy, the dose escalation of the cytokine mixture with cemiplimab starts in parallel to the ongoing monotherapy dose escalation, provided that the intended starting dose of the cytokine mixture for combination with cemiplimab has been evaluated for DLTs and cleared following an DLT observation period in the cytokine mixture monotherapy. The starting dose of the cytokine mixture for use in combination with cemiplimab is chosen when a DL of the cytokine mixture monotherapy has been cleared (DLT observation period [28 days] of a monotherapy dose has been completed), and signs of PK, PDy, and/or clinical response (systemic or local) with a monotherapy dose have been observed.
This starting dose of the cytokine mixture in combination with cemiplimab is either 1 dose below either the MTD or maximum administered dose (MAD) of the cytokine mixture administered in monotherapy, or a cleared DL in monotherapy. Systemic clinical response is assessed by measuring the objective response rate of the cytokine mixture administered intratumorally in monotherapy by evaluation of anti-tumor response information according to RECIST 1.1. The local clinical response is measured by RECIST 1.1 criteria, as well as additional signs of local response including flattening of the lesions and signs of inflammation. The cytokine mixture is administered in combination with cemiplimab intravenously at the fixed recommended dose of 350 mg Q3W.
The dose escalation in combination with cemiplimab proceeds with an adaptive dose escalation. The dose is cleared first in monotherapy before enrolling at the same DL in combination therapy.
The dose escalation in combination with cemiplimab proceeds with an adaptive dose escalation. The dose is cleared first in monotherapy before enrolling at the same DL in combination therapy. Enrollment to the next DL may not proceed before at least three participants treated at the previous DL have been followed for a duration of at least 28 days in combination), and are evaluable for DLT assessment with no DLT. The actual sample size in the dose escalation of the cytokine mixture in combination with cemiplimab may vary depending on DLTs observed and number of dose levels actually explored (approximately 18 to 36 DLT-evaluable participants).
There is a gap of at least one week between the first and second participants treated at the same dose level.
All dose levels (DL1-DL8) follow the guidance on lesion size provided in Table 5. Participants have a minimum of one measurable lesion as target lesion according to the Response Evaluation Criteria in Solid Tumors (RECIST 1.1) criteria (see Inclusion criterion I 05), and minimum of one or more cutaneous/subcutaneous lesion(s) for injection and tumor biopsy. Participants are selected based on the size of the tumor lesions which have to be sufficient for the injection volume of that given dose level (Table 5), with the consideration of biopsy of one lesion at baseline as well as between weeks 5th-8th of first administration as on-treatment assessment.
In the escalation phase only, if non-target lesions allow signal of response assessment, participants who have no measurable lesions may be evaluated case by case for eligibility with the agreement of study committee. Enrollment of patients with solely mucosal sites for injection is done only at dose levels in which significant inflammation of superficial, subcutaneous and/or lymph node metastases have not been observed with cytokine RNA mixture to minimize the risk of airway obstruction.
For the first treatment, among the 3 minimum lesions, one measurable lesion (cutaneous, visceral or lymph node) is left intact for measurements according to RECIST 1.1 criteria and one lesion is used for biopsy. If the lesion to be injected is large enough to be used for biopsy with no impact on dose administration at planned dose level, then two lesions are sufficient for eligibility. A minimum of one lesion is subject to administration of the cytokine RNA mixture (size of the lesion[s] should be assessed per dose level for participant's eligibility). The largest lesion(s) is injected first with the cytokine RNA mixture. For the remaining lesion(s), rank of injection is based on lesion size until maximum injection volume is used (see Table 7 below).
For all subsequent treatments (weekly), injection of lesion(s) is ranked based on lesion size until maximum injection volume is used or until all injectable lesion(s) are treated.
The volume to be injected is based on the size of the lesion, and the maximum injection volume for each treatment visit should not exceed the volume assigned for that DL for all injected lesions combined. The maximum injection volume allowed for DL8 is 4 mL.
If lesions are clustered together, they are injected as a single lesion according to the table and guidance above.
It is preferable to inject only one lesion per treatment based on the volume and size of the lesion ratio in Table 5. If it is not possible to inject only one lesion, then the volume/dose is divided in multiple lesions. At each visit, lesions for injection are prioritized based on size starting with the largest lesion first. The largest lesion is injected with maximum injection volume based on the lesion size and dose levels. If the volume is not all used, the next lesion is administered with maximum injection volume allowable for lesion size. Administration continues from largest to smallest until the entire dose volume has been administered.
When it is not possible to inject all lesions at each treatment visit or over the full course of treatment, previously injected and/or non-injected lesion(s) are injected at subsequent treatment visits. The cytokine mixture administration details per lesions are collected in the electronic case report form (eCRF).
Decisions to escalate consider the results of clinical safety. The DLT observation period is the first 4 weeks of treatment (Cycle 1). A participant is considered evaluable for DLT assessment if he/she receives at least 70% of his/her cohort planned cytokine mixture dose (monotherapy) or at least 70% of planned cytokine mixture dose and at least 70% of planned cemiplimab dose (combination therapy) during the first treatment cycle (i.e., DLT period) and is evaluated for 1 cycle, or if an earlier DLT occurs. Participants who are not evaluable for DLT assessment in the dose escalation phase (e.g., early progressive disease before Cycle 1 Day 28; any missing DLT assessment parameters) are replaced.
Monotherapy: For the escalation of the first two DLs, the second DL begins after the DLT observation period for the first participant is completed without an IMP-related AE Grade or DLT. If an IMP-related AE Grade or any DLT is observed at either of the first two DLs, two additional participants are treated at the same DL and dose escalation proceeds using an adaptive design. If no IMP-related AE Grade occurs in the first two DLs, then an adaptive Bayesian EWOC starts from DL3. Enrollment to DL2 or DL3 in the monotherapy part of the study may not proceed until the patient enrolled in DL1 or DL2 has been followed for 28 days, and is evaluable for AE assessment with no IMP-related Grade 2 AE.
Dose escalation is stopped as soon as the MTD is determined. If an MTD is not determined, dose escalation continues until the MAD is achieved.
Combination therapy with cemiplimab: No initial accelerated dose escalation step is implemented. The same adaptive rational design is used as for monotherapy.
Monotherapy: Based on the MTD/MAD, the overall safety, activity, and PK/PDy data, the recommended dose for the expansion phase is decided.
Up to 34 participants with advanced melanoma that have failed a prior therapy based on anti-PD-1/PD-L1 are enrolled at the MAD or MTD to further assess safety (especially any cumulative toxicity), anti-tumor activity, PDy, and PK activities.
Combination therapy with cemiplimab: The combination dose of the cytokine RNA mixture administered with cemiplimab for the expansion phase is determined based on safety data from the combination therapy dose escalation phase and available PK and/or PDy data. The dose expansion in combination includes up to 4 cohorts listed below (including patients with melanoma, CSCC, and HNSCC tumors); enrollment in all Cohorts (A, B, C, and D) are performed in parallel.
The combination therapy expansion phase cohorts includes:
The duration for each participant includes a period for screening of up to 28 days. The cycle duration is 28 days for monotherapy and 21 days for combination therapy. After completion of the first cycle, participants may continue to receive additional administrations of the cytokine RNA mixture at the same DL every week, if this dosing regimen is considered safe and the participant is achieving a clinical benefit. The expected treatment period for participants who benefit from the cytokine RNA mixture as monotherapy or in combination with cemiplimab may vary, based on progression date.
After discontinuation of intervention, participants return 30 days (for end-of-treatment [EOT] assessments) and 90 days (for ADA sample) after the last IMP administration or before the start of another anticancer therapy, whichever is earlier.
After the EOT visit, additional follow-up visits may be required to monitor all ongoing related and new related AEs until resolution or stabilization (i.e., an event ongoing without any change for at least 3 months). After the EOT, during the safety follow-up period, the events to be reported, monitored, and followed-up to resolution or stabilization are as follows: all ongoing AEs, SAEs, or Events of Special Interest regardless of relationship and all new AEs, SAEs, or Events of Special Interest considered related, including deaths due to related events.
In addition, if the participant discontinues intervention for reasons other than progression, follow-up visits are performed every 3 months until progression or initiation of another anti-tumor treatment, or death (whichever comes first) in order to document disease progression.
The total median estimated duration of enrollment is approximately 24 months. The expected duration of treatment for participants who benefit from the cytokine RNA mixture may vary, based on progression date; but median expected duration of treatment per participant is estimated as 9 months in monotherapy (1 month for screening, 5 months for treatment, and 3 months for the EOT and first follow-up visits) and 12 months in combination therapy (1 month for screening, 8 months for treatment, and 3 months for end of treatment follow-up).
Stopping Rules: in case of any deaths (other than death related to progressive disease (PD)) within 30 days of therapy, or Grade 4 TEAEs in more than one third of patients enrolled at a certain dose level (e.g. 2 out of 3 patients), enrollment in the trial will be paused until an appropriate evaluation of the cause of death and toxicity is conducted by the Study Committee and a correction plan is established.
The cytokine RNA mixture: The starting dose is generally established for anticancer compounds based on the results of toxicology studies in rodent and non-rodent species. The cytokine RNA mixture is administered via intratumoral injection, and its biological activity depends on uptake and translation of the administered mRNA. Preclinical toxicology studies were performed in non-tumor bearing rodent and non-rodent species, and surrogate routes of administration may not accurately reflect the intratumoral route of administration. As a result, the conventional procedure for determination of a first-in-human starting dose based on the International Council for Harmonisation (ICH) S9 recommendation of 1/10 the Severely Toxic Dose in 10% of the animals (STD 10) in rodents and no observed-adverse-effect-level (NOAEL) is not relevant for locally administered intratumoral mRNA agents.
To determine a starting dose for human, in vivo experiments are performed in immunocompromised mice bearing human A375 melanoma xenografts. Intratumoral administration of the cytokine RNA mixture in the A375 xenograft leads to translation of each of the cytokine components of the cytokine RNA mixture. While the cytokine mixture is expressed locally within the tumor, the encoded cytokines are secreted and enter into circulation leading to systemic exposure to the cytokines. The PK parameters of the cytokines encoded by the cytokine RNA mixture are assessed. The serum PK parameters of the cytokine RNA mixture encoded cytokines in the A375 xenograft showed a dose-dependent expression relationship.
Assuming a comparable tumor expression potential of the cytokine RNA mixture encoded cytokines between mouse and human, the individual PK models in mouse are scaled to human using allometry, and simulations are performed to predict the human systemic cytokine exposure at different dose levels of the cytokine RNA mixture. Due to the uncertainties of pharmacological activity in humans versus animals and interspecies differences related to cytokines, a wide safety margin is applied, and a human dose is selected.
Cemiplimab: The 350 mg Q3W dosing regimen is selected based on Regeneron's previous clinical trials. The Q3W dosing interval was selected.
A participant is considered to have completed the study if he/she has completed all phases of the study intervention up to a maximum of 1 year (including End of Treatment), or if treatment is terminated due to another reason and the participant completed follow-up visits until progressive disease.
There are two cut-off dates for the study:
The first trial cut-off date for the monotherapy or combination therapy is at the end of Cycle 1 of the last participant treated in the respective dose escalation phase in order to have all participants with evaluable DLT data for determination of the MTD/MAD.
The second cut-off date is either when the last participant on treatment in the expansion phase will have had two post-baseline tumor assessments or end of treatment assessment, whichever occurs first, in order to assess tumor response.
If a participant, treated in either the dose escalation phase or the expansion phase, continues to benefit from the treatment after the second study cut-off, the participant can continue study intervention (for up to 1 year of treatment) and will undergo assessments for IMP-related AEs, any SAE, and blood samples for assay of immunogenicity, if applicable.
The end of the study is defined as the date of the last visit of the last participant in the study.
Participants are eligible to be included in the study only if all of the following criteria apply as shown in Table 8.
Participants are excluded from the study if any of the following criteria apply as shown in Table 9.
Study intervention is defined as any investigational intervention(s), marketed product(s), placebo, or medical device(s) intended to be administered to a study participant according to the study protocol.
aNo predefined premedication will be administered to all participants, but secondary premedication might be recommended for some participants.
The cytokine RNA mixture is the investigational medicinal product and is a 1:1:1:1 weight ratio of synthetic, chemically modified mRNAs encoding the human cytokines IL-15sushi, IL-12sc, GM-CSF, and IFNα2b.
The cytokine RNA mixture is administered intratumorally once per week in a 4-week cycle (i.e., four doses every 28 days). After each cycle of treatment, the frequency of intratumoral injection continues weekly. However, during the conduct of the study, the dose administration frequency may be reduced to less frequent administration based on tumor burden decrease, which may interfere with administration of the intended dose.
As the route of administration is intratumoral injection, no acute allergic reaction is expected so there is no pre-defined premedication to be administered to all participants; however, premedication may be recommended for some participants. All the drugs used as premedication are entered to the concomitant medication pages.
In case of TLS, study treatment (cytokine mRNA mixture) should be held until all serum chemistries have resolved. To ensure normal hydration, correct laboratory abnormalities, fluid overload, electrolyte or acid-base deviation. Management must be done according to the local site guideline. Use of inhibitors (e.g., allopurinol) or urate oxidase (e.g., rasburicase) is allowed. TLS complications including renal function should be monitored, and study treatment can be reinstituted at full doses after resolution.
The laboratory abnormalities normally associated with TLS, and the possible clinical manifestations which can be associated with TLS are presented in Table 11.
aThe corrected calcium level in milligrams per deciliter = measured calcium level in milligrams per deciliter + 0.8 x (4-albumin in grams per deciliter)
Any medication (including over-the-counter or prescription medicines, vitamins, and/or herbal supplements) that the participant is receiving at the time of enrollment or receives during the study must be recorded with reason for use, and dates of administration including start and end date.
Concomitant medications are recorded in the eCRF from 14 days prior to the initial dose of study drug until 30 days after the last administration of study drug, resolution of ongoing study-drug related adverse events, or when another anticancer therapy is received.
Concomitant medication may be considered on a case-by-case, in accordance with the following guidelines:
Any prior anticancer therapy participant received before start of this study (medications and therapies including radiotherapies) should be entered in the eCRF.
Any previous treatment should have been finished according to the following timelines:
If a participant receives maintenance therapy with corticosteroids, the participants is eligible only if the dose can be tapered to <7.5 mg/day by 2 weeks before the first administration of IMP, and the participant should not have the risk of dose increase throughout the study intervention period.
As the route of administration is intratumoral injection, no acute allergic reaction is expected so there is no pre-defined premedication to be administered to all participants; however important identified risks with cemiplimab intravenous administration include immune-related reactions and infusion-related hypersensitivity. Premedication at and following the second cycle may be recommended depending on whether the participant experienced an inflammatory reaction following the first administration.
If participants had previously experienced drug-induced related allergic reactions (i.e., from mild itching to moderate symptoms that occurred within 24 hours of IMP administration), premedication with a histamine H1 antagonist (diphenhydramine 50 mg orally, or equivalent [e.g., dexchlorpheniramine], given approximately 30-60 minutes before administration of the cytokine RNA mixture) can be considered before administration of the cytokine RNA mixture. If participants had Grade 2 events including hypersensitivity or CRS, premedication might also include oral steroids (dexamethasone 20 mg or equivalent) for future administrations. Corticosteroid usage should be limited to the treatment of severe drug induced allergic reactions or life-threatening conditions.
Premedication with antipyretics is permitted for participants who developed inflammatory symptoms such as fever and shivering after the first administration of the IMP. Local anesthetics can be used based on location of lesion(s) to be injected.
Use of the following therapies is prohibited during the study:
Dose Modification for the Cytokine RNA Mixture
If necessary or in case of an IMP-related Grade ≥2 AE, the start of the cytokine RNA mixture can be delayed by up to 3 days beyond the anticipated day of treatment at any week, and a delay of 2 or 3 days will be considered as a dose delay. The next dose should be planned 7 days after the last dose to respect a 7 day interval between doses.
If the cytokine RNA mixture dose needs to be delayed ≥4 days beyond the anticipated day of treatment for the weekly dose, then that dose needs to be skipped and will therefore be considered a dose omission. The participant may resume the cytokine RNA mixture if the IMP-related Grade ≥2 AE has resolved to Grade ≤1 (or Grade 2 if controlled with replacement therapies) within an acceptable period. In case of two sequential dose omissions, the patient may be re-treated with the cytokine RNA mixture if the AE is not life-threatening and continuation of treatment is considered best for the patient's condition. In case of more than two sequential dose omissions the cytokine RNA mixture will be terminated definitively.
Participants who experience a DLT in the monotherapy dose escalation part of the study, will have their study intervention stopped and will be followed until the toxicity has resolved.
Applicable only to dose escalation (not expansion phase), the participant will resume therapy with a new cycle of treatment at the same dose level of the cytokine RNA mixture with prophylactic treatment (if available) or at a lower dose level, based on agreement with the Sponsor. No dose re-escalation is allowed.
In the event of DLTs attributed to the cytokine RNA mixture whose re-occurrence would not necessarily be life-threatening (ie, skin rash not related to CRS, endocrinopathies such as hypothyroidism, fever, fatigue, arthromyalgia, headache) and recovery to CTCAE Grade ≤1 or baseline values occurs promptly, the situation will be evaluated on a case by case basis and determine if it is safe to resume therapy at the same dose level or at a lower dose level and if it is in accordance with the benefit/risk balance for the participant. On the contrary, in the event of DLTs whose re-occurrence could be potentially life threatening (i.e., cytokine release syndrome, pneumonitis) then participants will be removed from further treatment and will not be replaced.
Dose Modification for Cemiplimab
Cemiplimab infusion should be interrupted, withheld or permanently discontinued due to adverse events as described herein (Cemiplimab recommended dosage modifications for adverse reactions). Cemiplimab can be resumed in patients with complete or partial resolution (Grade 0 to 1) following a corticosteroid taper.
If cemiplimab is permanently discontinued due to specific AE(s) (e.g., drug-induced infusion-related allergic reaction) in a participant who is also receiving the cytokine RNA mixture, the participant will continue to receive the cytokine RNA mixture until the defined criteria for permanent study treatment discontinuation of the cytokine RNA mixture are met.
Regardless if the cytokine RNA mixture is delayed by up to 3 days beyond the anticipated day of treatment at any week, cemiplimab should be administered the same day as the cytokine RNA mixture.
The treatment administration window for cemiplimab is ±3 days. If cemiplimab is withheld, the start of cemiplimab can be delayed by up to 3 days beyond the anticipated day of treatment at any week, and a delay of 2 or 3 days will be considered as a dose delay. The next dose of cemiplimab should be planned 21 days after the last dose to respect a 21 day interval between doses.
If cemiplimab dose needs to be delayed ≥4 days beyond the anticipated day of treatment, then that dose needs to be skipped and will therefore be considered a dose omission, the cytokine RNA mixture is administered at next planned date. The participant may resume cemiplimab if toxicity has completely or partially resolved (Grade 0 to 1) after a recommended corticosteroid taper. In case of two sequential dose omissions, the patient may be re-treated with cemiplimab if the AE is not life-threatening and continuation of treatment is considered best for the patient's condition. In case of more than two sequential dose omissions cemiplimab will be terminated indefinitely.
Participants who experience a DLT in the combination dose escalation part of the study, both the cytokine RNA mixture and cemiplimab will be stopped and the patient will be followed until the toxicity has resolved.
Applicable only to dose escalation (not expansion phase), the participant will resume therapy with a new cycle of treatment at the same dose level of the cytokine RNA mixture and fixed dose of cemiplimab (350 mg) with prophylactic treatment (if available) or at a lower dose level, based on agreement with the Sponsor. No dose re-escalation is allowed for the cytokine RNA mixture.
If a DLT definitively related to cemiplimab occurs in a participant who is also receiving the cytokine RNA mixture causing cemiplimab to be terminated indefinitely, the participant may continue to receive the cytokine RNA mixture until the defined criteria for permanent study treatment discontinuation of the cytokine RNA mixture are met.
Participants receiving cemiplimab remain on the assigned dosage throughout the course of study treatment (350 mg Q3W), and no dose modifications are allowed for this IMP. The treatment cycle may be delayed or cemiplimab may be omitted in case of an ongoing AE that interferes with study intervention.
Infusion-related allergic reactions can occur during cemiplimab treatment. Emergency equipment and medication for the treatment of these potential adverse events (e.g., antihistamines, bronchodilators, IV saline, corticosteroids, acetaminophen, and/or epinephrine) are available for immediate use.
The cemiplimab infusion is interrupted if any of the following AEs are observed: cough, rigors/chills, rash, pruritus, urticaria (e.g., hives, welts, or wheals), diaphoresis (sweating), hypotension, dyspnea (shortness of breath), vomiting, or flushing. The reaction(s) is treated symptomatically, and the infusion may be restarted at 50% of the original rate.
In the event of an infusion reaction of Grade severity during or directly following cemiplimab infusion, dosing is stopped, and the patient permanently discontinues cemiplimab treatment. Vital signs are closely monitored.
If a participant has a cemiplimab infusion-related allergic drug reaction that leads to the termination of cemiplimab treatment, the participant may continue the cytokine mixture treatment at the assigned dose level as monotherapy, if the continuation of therapy is considered to be the best option for the participant, based on case-by-case assessment.
Discontinuation/Withdrawal. In case the IMP is discontinued, it is determined whether this discontinuation is temporary (i.e., a dose omission or cycle delay); permanent IMP discontinuation before disease progression, unless reaching the end of 1-year treatment period, is a last resort. Any IMP discontinuation must be fully documented in the eCRF. In any case, the participant should remain in the study until the documentation of progressive disease.
Definitive Discontinuation of Study Intervention: Permanent intervention discontinuation is any intervention discontinuation associated with the definitive decision from the Investigator not to re-expose the participant to the IMP at any time during the study, or from the participant not to be re-exposed to the IMP whatever the reason.
Study intervention is discontinued if, in the Investigator's opinion, continuation of the study intervention is detrimental to the participant's wellbeing, such as in any of the following cases:
1. Unacceptable adverse event.
2. Confirmed disease progression.
3. Poor compliance to the study protocol.
4. Completion of the 1-year treatment period.
5. Other conditions, such as concurrent illness, that prevents further administration of study intervention.
If participants are clinically stable, and deriving clinical benefit from therapy with minimal toxicity, they will be maintained on treatment until progressive disease or for a maximum treatment of 1 year, whichever comes first. If only one of the IMPs is permanently discontinued due to specific AE(s) (e.g., drug-induced infusion-related allergic reaction) in a participant who received combination therapy, the participant continues receiving the other IMP until the defined criteria for permanent study treatment discontinuation are met.
Discontinuation of study intervention for abnormal liver function is considered by the Investigator when the increase is not related to the underlying disease and if the Investigator believes that it is in the best interest of participant safety.
Participants may withdraw from treatment with IMPs if they decide to do so, at any time and irrespective of the reason, or this may be done at the discretion of the Investigator. Treatment with the IMP should be discontinued in any of the following cases: At the participant's request, at any time and irrespective of the reason (consent's withdrawal), or at the request of their legally authorized representative.
“Legally authorized representative” is considered to be an individual or judicial or other body authorized under applicable law to consent on behalf of a prospective participant to the participant's participation in the procedure(s) involved in the research. Withdrawal of consent for treatment is distinguished from withdrawal of consent for follow-up visits and from withdrawal of consent for non-participant contact follow-up, e.g., medical records check.
Participants requesting withdrawal are informed that withdrawal of consent for follow-up may jeopardize the public health value of the study. Participants who withdraw are explicitly asked about the contribution of possible AEs to their decision to withdraw consent, and any AE information elicited is documented. Preferably the participant withdraws consent in writing and, if the participant or the participant's representative refuses or is physically unavailable, the site documents and signs the reason for the participant's failure to withdraw consent in writing.
Participants are followed-up according to the study procedures specified in this protocol up to the scheduled date of study completion, or up to recovery or stabilization of any AE to be followed-up as specified in this protocol, whichever comes last.
If possible, and after the permanent discontinuation of intervention, the participants are assessed using the procedure normally planned for the last dosing day with the IMP including a pharmacokinetics sample, if appropriate.
All cases of permanent intervention discontinuation are recorded by the Investigator in the appropriate pages of the eCRF when considered as confirmed.
A participant is considered lost to follow-up if he or she repeatedly fails to return for scheduled visits and is unable to be contacted by the study site.
The following actions are taken if a participant fails to return to the clinic for a required study visit:
Procedures conducted as part of the participant's routine clinical management (e.g., blood count) and obtained before signing of the ICF may be utilized for screening or baseline purposes provided the procedures met the protocol-specified criteria and are performed within the time frame defined in the SoA.
Repeat or unscheduled samples may be taken for safety reasons or for technical issues with the samples.
In the escalation phase, the objective response information is obtained based on RECIST 1.1, if there are measurable intact lesions based on RECIST 1.1.
In the expansion phase, the assessment of response to the cytokine RNA mixture is a primary objective. All participants treated in the expansion phase must have at least one measurable intact lesion for inclusion (see above inclusion criterion I 05). Tumor assessment is performed at fixed intervals as described in the Schedule of Activities (SOA) in Tables 2 and 3, and the assessment window is not impacted by dose delay or dose omission.
All tumor assessment data are recorded to related eCRF pages based on RECIST 1.1 criteria. As a requirement of RECIST 1.1 criteria, a partial or complete response must be confirmed on a second examination done at least 4 weeks apart, in order to be documented as a confirmed response to therapy. Based on RECIST for immunotherapies (iRECIST), progressive disease should also be confirmed on a second examination done at least 4 weeks apart to exclude pseudoprogression, in case of no clinically progressive disease.
The RECIST 1.1 criteria are followed for assessment of tumor response, and iRECIST criteria also are followed for reporting response criteria as secondary/exploratory endpoints. In case progressive disease is confirmed on second assessment, the date of progression is recorded based on the initial assessment. If disease progression is not confirmed, participants continue the treatment and unconfirmed progressive disease (iUPD) is recorded.
All measurable lesions (even those below the threshold value of measurability based on RECIST 1.1), are measured for optimization of study intervention. An exploratory analysis, as part of an efficacy assessment in terms of ORR, is performed by assessment of total tumor volume with consideration of the size of the non-target lesions, and analyses of injected versus non-injected lesions will be part of this exploratory assessment. Measurement procedures and documentation in eCRF are detailed in SRM, and statistical analyses plan is detailed in the SAP.
Secondary efficacy variables include disease control rates, duration of response, and progression free survival. All these parameters are detailed in the SAP.
ORR is defined as the proportion of participants with CR, and PR based on responses as assessed using the 5-point scale as per Lugano classification 2014 (Cheson B D et al. (2014) J Clin Onc 32(27):3059-68).
Tumor assessment includes FDG-PET-CT scan in case of FDG-avid lymphomas and contrast enhanced CT in case of non-FDG avid lymphomas. Tumor assessments are performed at fixed intervals as described in SoA, and the assessment window is not impacted by dose delay or dose omission.
If CT and/or PET scans at screening are negative for disease involvement in the neck, subsequent CT scans may not include the neck area. If PET and/or CT scans at screening are positive for disease involvement in the neck, subsequent CT scans must include the neck area. Tumor response assessments should occur at Screening (within 28 days [−7 days] prior to first IMP), and every 12 weeks (±7 days) thereafter. Imaging timing should follow calendar days and should not be adjusted for delays in cycle. For participants who discontinue for reasons other than PD, assessments should continue until the participant has documented PD or start a new anti-cancer therapy. The first assessment may be performed earlier than 12 weeks if in the opinion of the investigator the participant is clinically progressing.
If participants have a PR, or a CR a repeated scan 4 weeks apart is required for confirmation and patients should continue on every 12 week assessment schedule. In the setting where a participant is clinically stable, but imaging shows PD at Week 12, study drug may be continued, at the discretion of the investigator, until the next disease response assessment. However, imaging should occur at any time when there is clinical suspicion of progression.
Assessment of lymphoma B symptoms should occur with each disease response assessment.
In participants with PD at Week 12, who continue study therapy beyond Week 12 a radiological assessment is performed at the time of treatment discontinuation. If previous scan was obtained within 4 weeks prior to the date of discontinuation, then a repeat scan at treatment discontinuation is not mandatory.
All participants may have bone marrow biopsy/aspirate performed as clinically indicated as per Lugano 2014 criteria (Cheson B D et al. (2014)). FDG-PET-CT is adequate for determination of bone marrow involvement and can be considered highly suggestive for involvement of bone marrow. Bone marrow biopsy confirmation can be considered if necessary at baseline (if the FDG-PET-CT is negative in the bone marrow site then biopsy/aspirate is performed to identify involvement). Subsequent bone marrow assessments will only be performed in participants who have bone marrow involvement at baseline.
The major purpose of this FIH study is to establish, based on DLTs, the biologically optimal dose of the cytokine RNA mixture when administered as a weekly intratumoral injection. Safety is thus a primary study endpoint and is assessed continuously. The safety profile is assessed from the findings of physical examination (preferably by the same physician) and laboratory tests and will be based on incidence, severity (as graded by the NCI CTCAE ver. 5.0), and cumulative nature of AEs. Planned time points for all safety assessments are provided in the SOA.
A complete physical examination includes, at minimum, assessments of the Central Nervous System and the cardiovascular, respiratory, gastrointestinal, hematopoietic (hepatomegaly, splenomegaly, lymphadenopathy), and dermatological systems. Height (only at baseline) and weight (at pre-dose of each cycle) is measured and recorded in the eCRF.
ECOG performance status is assessed before each IMP administration and recorded in the eCRF. Investigators pay attention to clinical signs related to previous serious illnesses, as well as progress of skin lesions. Any new finding or worsening of previous finding are reported as a new adverse event. The schedule for physical examinations is described in the SOA.
During treatment phase, vital signs are monitored just before starting infusion of the IMP and at the end of injection. Monitoring is also performed as clinically indicated. Temperature, pulse rate, respiratory rate, and blood pressure are assessed. Blood pressure and pulse measurements should be preceded by at least 5 minutes of rest for the participant in a quiet setting without distractions (e.g., television, cell phones).
Single 12-lead ECGs are obtained as outlined in the SOA. Clinically significant abnormalities should be reported as AE, developed following signing of the ICF. Preexisting conditions should be recorded in the participant's medical history. Echocardiograms or MUGA scans will be obtained as outlined in the SoA (see herein) only at screening for patients in the combination part of the study.
DLCO is performed at baseline for participants with lymphoma previously treated with bleomycin. Pulmonary function testing is required only for patients in the combination escalation arm with cemiplimab.
The Investigator reviews the laboratory report and documents this review. The laboratory reports are filed with the source documents. Laboratory abnormalities are reported as AEs only in the event they:
All protocol-required laboratory assessments are conducted in accordance with the laboratory manual and the SoA.
If laboratory values from non-protocol specified laboratory assessments performed at the institution's local laboratory require a change in participant management or are considered clinically significant by the Investigator (e.g., SAE or AE or dose modification), then the results are recorded in the eCRF. All unplanned laboratory tests performed for safety follow-up or for further investigation of AE are reported in the eCRF.
DLTs are defined as any of the following AEs related to the IMPs in the absence of clear evidence to the contrary, after validation by the Study Committee, and if not related to a disease progression grading using NCI CTCAE ver. 5.0. The duration of the DLT observation period is longer for participants who delay initiation of Cycle 2 due to treatment-related AE for which the duration must be assessed in order to determine if the event is a DLT. The NCI CTCAE ver. 5.0 is used to assess the severity of AEs.
Hematological toxicity:
Non-hematological toxicity:
Other “non-gradable” toxicities:
The occurrence of DLTs during the first 28 days of treatment for the escalation phase is used to define the MTD or MAD. In Cycle 1 and in subsequent cycles, the occurrence of DLTs determines the need for dose omissions or reductions (if the DLT occurs during the DLT observation period, study intervention is terminated definitively; beyond the DLT observation period).
Participants who experience a DLT will have their therapy with the cytokine RNA mixture stopped and they will be followed until this toxicity has resolved to CTCAE Grade ≤1 or to the participant's baseline value, if higher. After recovery from the toxicity in question, with a maximum of 2 dose omission and agreement of the Study Committee, and if the Investigator believes that it is in the participant's best interest to resume therapy with the cytokine RNA mixture, the participant may resume therapy with a new cycle of treatment at the same dose level or at a lower dose level, based on agreement with the Sponsor. No dose re-escalation is allowed for such re-dosed participants.
Management of hypersensitivity and anaphylactic reactions, along with associated dose modifications, is detailed below.
Systemic Inflammatory Reaction
Systemic reaction due to inflammatory reactions may occur with the cytokine RNA mixture administration. Antigen-specific T-lymphocyte responses, TLR-mediated signaling, and the transient release of pro-inflammatory cytokines may cause systemic inflammatory reactions. Typical clinical symptoms of systemic inflammatory reactions may include tachycardia, reduced blood pressure, dyspnea, shivers, vomiting, dizziness, and fever.
Possible actions in case of systemic inflammatory reactions are:
Cytokine Release Syndrome
Cytokine-associated toxicity, also known as CRS, is a non-antigen specific toxicity that occurs as a result of potent immune activation. CRS clinically manifests when large numbers of lymphocytes (B cells, T cells, and/or NK cells) and/or myeloid cells (macrophages, dendritic cells, and monocytes) become activated and release inflammatory cytokines. CRS has classically been associated with therapeutic monoclonal antibody infusions, and in these settings symptom onset typically occurs within minutes to hours after the infusion begins. Though it is not expected that serum cytokine levels following intratumoral injection with the cytokine RNA mixture will approach levels observed in participants following direct injection of recombinant cytokines, there is a possibility that, in the course of sustained intratumoral cytokine levels providing clinical benefit, participants may have sustained levels of systemic cytokine levels which could cause adverse effects. Thus, participants receiving intratumoral injections of the cytokine RNA mixture are monitored closely for signs of cytokine-associated toxicities. In case a participant develops Grade 2 or higher signs and symptoms of CRS he/she needs to be hospitalized. Vital signs monitoring shall be made continuously if CRS Grade develops. The participant should be transferred to the intensive care unit (ICU) in case he/she develops hemodynamic or respiratory compromise. The ICU should be staffed by a critical care physician who has experience in treating CRS. In addition, the ICU must have the necessary equipment to commence immediate treatment and monitoring of a participant with CRS Grade before he/she is admitted to ICU.
For clinical signs and symptoms associated with CRS, see below.
The timing of symptom onset and CRS severity depends on the inducing agent and the magnitude of immune cell activation. The incidence and severity of the syndrome also appears greater when patients have large tumor burdens, presumably because this leads to higher levels of T-cell activation. As with CRS associated with monoclonal antibody therapy, CRS associated with adoptive T-cell therapies has been associated with elevated IFNγ, IL-6, and TNFα levels; increases in IL-2, GM-CSF, IL-10, IL-8, IL-5, and fracktalkine have also been reported. Emerging evidence implicates IL-6 as a central mediator of toxicity in CRS; IL-6 is a pleiotropic cytokine with anti-inflammatory and proinflammatory properties. However, real time analysis of a broad panel of cytokines does not significantly impact management of individual patients with CRS at the current time and treatment decisions are typically based on clinical parameters.
Assays for serum C-reactive protein (CRP) and ferritin are performed. Plasma levels of cytokines, including IL-6 and IFNγ, are collected and retrospectively analyzed only in case of development of CRS Grade ≥2 symptoms. Sampling is performed following the initial dose and after each dose increase, in order to assess for signs of CRS, and in case of development of CRS Grade ≥2 symptoms. CRP is an acute phase reactant produced by the liver, largely in response to IL-6. Serum CRP levels serve as a surrogate for increases in IL-6 bioactivity. During CRS, serum CRP levels may increase by several logs. The serum CRP assay is rapid, inexpensive, and readily available in most hospitals. In some series, peak CRP levels and fold change in CRP have identified patients at risk for severe CRS. It is important to emphasize, however, that CRP levels are also elevated during infection and cannot be used to distinguish between inflammation caused by infection and inflammation related to CRS. Extreme elevations in serum ferritin have been observed in many patients with CRS after chimeric antigen receptor (CAR) T-cell infusion, which supports a resemblance between CRS and macrophage activation syndrome/hemophagocytic lymphohistiocytosis (HLH).
To assess the severity of CRS in individual participants, the grading system and mitigation strategy for CRS that is based on the 2014 NCI Consensus Guidelines are used. This grading system was modified to define mild, moderate, severe, and life-threatening CRS regardless of the inciting agent and to guide treatment recommendations with corticosteroids and/or anti-human IL-6 monoclonal antibodies such as tocilizumab.
Adverse Event of Special Interest
An AESI is an AE (serious or nonserious) of scientific and medical concern specific to the Sponsor's product or program, for which ongoing monitoring and immediate notification by the Investigator to the Sponsor is required. Such events may require further investigation in order to characterize and understand them. Adverse events of special interest may be added, modified or removed during a study by protocol amendment.
AE is reported by the participant (or, when appropriate, by a caregiver, surrogate, or the participant's legally authorized representative).
The Investigator and any qualified designees are responsible for detecting, documenting, and recording events that meet the definition of an AE or SAE and remain responsible for following up AEs that are serious, considered related to the study intervention or study procedures, or that caused the participant to discontinue the Cytokine RNA mixture.
Adverse Event (AE)
An AE is any untoward medical occurrence in a participant or clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention. AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of study intervention.
Serious Adverse Event (SAE)
A SAE is any untoward medical occurrence that at any dose:
A treatment-emergent adverse event (TEAE) is defined as an AE that is reported during the on-treatment period up to 30 days after last dose of study interventions.
Related Adverse Event: there is a reasonable possibility according to the Investigator Sponsored Studies (ISS) that the product may have caused the event. The causality of the SAE (i.e., its relationship to study intervention) will be assessed by the physician, who is completing the CRF. For regulatory reporting purposes, if the relationship is unknown or unstated, it meets the definition of an adverse drug reaction (suspected association—ADR).
Immune-related Adverse event (ir-AE): a subset of treatment related adverse events, is defined as a clinically significant adverse event of any organ that is associated with immune based therapy (e.g., immune check point inhibitor exposure), of unknown etiology, and is consistent with an immune-mediated mechanism.
Adverse Event of Special Interest (AESI): an adverse event (serious or nonserious) of scientific and medical concern specific to the Sponsor's product or program, for which ongoing monitoring and rapid communication by the Investigator to the Sponsor may be appropriate. Such events may require further investigation in order to characterize and understand them. AESIs may be added or removed during a study by protocol amendment.
New safety finding: any finding other than reportable individual case safety report (ICSR) or safety issue that may impact the known risk-benefit balance or the safety profile of the product.
Expected AE/SAE: The determination of expectedness under an approved indication and regimen of the product is to be determined based on local label (if available) or EU Summary of Product Characteristics (SmPC). When the product is administered in any non-approved combination/regimen, or for a non-approved indication/population, or for a non-approved dosing, the determination of expectedness should be based on the IB (consider the labeling of each specific marketed drug within the combination, based upon reference documents as defined in the study protocol).
Suspected unexpected serious adverse reaction (SUSAR): Causality, seriousness and expectedness are independent criteria. It is a combination, which defines expedited reporting to Health Authorities.
Events Meeting the AE Definition:
Events NOT Meeting the AE Definition:
If an event is not an AE per definition above, then it cannot be an SAE even if serious conditions are met (e.g., hospitalization for signs/symptoms of the disease under study, death due to progression of disease).
Recording and Follow-Up of AE and/or SAE
AE and SAE Recording
When an AE/SAE occurs, all documentation (e.g., hospital progress notes, laboratory reports, and diagnostics reports) related to the event are reviewed and all relevant AE/SAE information in the eCRF are recorded. There may be instances when copies of medical records for certain cases are requested by the Sponsor. In this case, all participant identifiers, with the exception of the participant number, are redacted on the copies of the medical records before submission to the Sponsor. The Investigator attempts to establish a diagnosis of the event based on signs, symptoms, and/or other clinical information. Whenever possible, the diagnosis (not the individual signs/symptoms) is documented as the AE/SAE.
Assessment of Intensity
Intensity of AE/SAE is assessed based on NCI CTCAE version 5.0.
Assessment of Causality
The Investigator is obligated to assess the relationship between study intervention and each occurrence of each AE/SAE. A “reasonable possibility” of a relationship conveys that there are facts, evidence, and/or arguments to suggest a causal relationship, rather than a relationship cannot be ruled out. The Investigator uses clinical judgment to determine the relationship. Alternative causes, such as underlying disease(s), concomitant therapy, and other risk factors, as well as the temporal relationship of the event to study intervention administration will be considered and investigated. The Investigator also consults the Investigator's Brochure (IB) and/or Product Information, for marketed products, in his/her assessment.
For each AE/SAE, the Investigator must document in the medical notes that he/she has reviewed the AE/SAE and has provided an assessment of causality. There may be situations in which an SAE has occurred, and the Investigator has minimal information to include in the initial report to the Sponsor. However, it is very important that the Investigator always assess causality for every event before the initial transmission of the SAE data to the Sponsor. The Investigator may change his/her opinion of causality in light of follow-up information and send a SAE follow-up report with the updated causality assessment.
Follow-Up of AEs and SAEs
The Investigator is obligated to perform or arrange for the conduct of supplemental measurements and/or evaluations as medically indicated or as requested by the representative of the monitoring team to elucidate the nature and/or causality of the AE or SAE as fully as possible. This may include additional laboratory tests or investigations, histopathological examinations, or consultation with other health care professionals. New or updated information will be recorded in the originally completed eCRF.
Reporting of SAEs
SAE reporting to the Sponsor via an electronic data collection tool. The primary mechanism for reporting an SAE to the Sponsor is the electronic data collection tool. If the electronic system is unavailable for more than 24 hours, then the site uses the paper SAE data collection tool (see next section). The site enters the SAE data into the electronic system as soon as it becomes available. After the study is completed at a given site, the electronic data collection tool is taken off-line to prevent the entry of new data or changes to existing data. If a site receives a report of a new SAE from a study participant or receives updated data on a previously reported SAE after the electronic data collection tool has been taken off-line, then the site can report this information on a paper SAE form (see next section) or to the Sponsor or representative by facsimile.
SAE Reporting to the Sponsor Via Paper CRF
Facsimile transmission of the SAE paper CRF is the preferred method to transmit this information to the Sponsor or representative. In rare circumstances and in the absence of facsimile equipment, notification by telephone is acceptable with a copy of the SAE data collection tool sent by overnight mail or courier service. Initial notification via telephone does not replace the need for the Investigator to complete and sign the SAE CRF pages within the designated reporting time frames.
All AEs (including SAEs) are collected from the signing of the ICF until EOT at the time points specified in the SOA. After EOT, only IMP-related or unexpected events (including those for which the relationship to IMP is unclear) are reported.
All SAEs and AESI are recorded and reported to the Sponsor or designee within 24 hours, as indicated below. The Investigator submits any updated SAE data to the Sponsor within 24 hours of it being available.
Investigators are not obligated to actively seek AE or SAE after conclusion of the study participation. However, if the Investigator learns of any SAE, including a death, at any time after a participant has been discharged from the study, and he/she considers the event to be reasonably related to the study intervention or study participation, the Investigator must promptly notify the Sponsor.
The method of recording, evaluating, and assessing causality of AE and SAE and the procedures for completing and transmitting SAE reports are provided below.
Care is taken not to introduce bias when detecting AEs and/or SAEs. Open-ended and non-leading verbal questioning of the participant is the preferred method to inquire about AE occurrences.
After the initial AE/SAE report, the Investigator is required to proactively follow each participant at subsequent visits. After the EOT, during the safety follow-up period, the events to be reported, monitored, and followed-up to resolution or stabilization are as follows:
Further information on follow-up procedures is given below.
The following disease related events (DREs) are common in participants with cancer and can be serious/life threatening:
Because these events are typically associated with the disease under study, they are not reported according to the standard process for expedited reporting of SAEs even though the event may meet the definition of a SAE. These events are recorded on the corresponding page in the participant's eCRF within the appropriate time frame.
However, if either of the following conditions applies, then the event must be recorded and reported as an SAE (instead of a DRE): the event is, in the Investigator's opinion, of greater intensity, frequency, or duration than expected for the individual participant; or the Investigator considers that there is a reasonable possibility that the event was related to study intervention.
Pregnancy:
Details of all pregnancies in female participants and, if indicated, female partners of male participants will be collected after the start of study intervention and at least 6 months after the last dose of study intervention.
If a pregnancy is reported, the Investigator informs the Sponsor within 24 hours of learning of the pregnancy. Abnormal pregnancy outcomes (e.g., spontaneous abortion, fetal death, stillbirth, congenital anomalies, ectopic pregnancy) are considered SAEs. Pregnancy follow-up describes the outcome of the pregnancy, including any voluntary or spontaneous termination, details of the birth, the presence or absence of any congenital abnormalities, birth defects, maternal or newborn complications and their presumed relation to the study drug.
The following blood collection time points are defined to measure concentrations of cytokines encoded by the cytokine RNA mixture in plasma and conduct the PK analysis:
The sampling times for blood collection can be found in the PK/PDy flow chart (Table 3). It is of utmost importance to collect all blood samples at the specified times and according to the specifications.
Samples missed or lost for any reason are recorded. Actual times of blood collection are recorded in the eCRF. The dates and times of sampling and drug administration are also precisely recorded.
For Cohorts A, B, C, and D in the combination therapy expansion phase, dense sampling subsets consist of a minimum of 10 participants from each cohort who has dense sampling during Cycle 1 Week 1 and Cycle 3 Week 1 (Tables 4 and 5). All participants in the combination therapy escalation phase undergo sparse sampling.
Bioanalytical methods are summarized in Table 9. Briefly, systemic levels of the four target cytokines (IL-12sc, IL-15 sushi, GM-CSF, and IFNα2b) translated from the cytokine RNA mixture in plasma are monitored retrospectively in each participant cohort. These cytokine assays (IL-12sc, GM-CSF, IFNα, and IL-15 sushi) are performed on either the MSD or Quanterix SIMOA platforms based on needs for detection sensitivity. For participants receiving combination therapy, the cemiplimab concentrations are monitored in serum according to the PK/PDy flowchart (Table 5), using an immunoassay developed and validated by Regeneron.
Pharmacokinetic parameters are calculated with PKDMS software (Pharsight), using non compartmental methods, from intensively sampled plasma concentrations of cytokines encoded by the cytokine RNA mixture and of intensively sampled serum concentrations of cemiplimab.
The PK parameters for the cytokines encoded by the cytokine RNA mixture include, but are not limited to, those listed in Table 13.
Population PK approaches may be used for cytokines encoded by the cytokine RNA mixture. If done, the data generated are reported in a standalone report(s).
The PK parameters for cemiplimab include, but are not limited to, those listed in Table 14.
Target engagement, PDy, and safety biomarkers of the cytokine RNA mixture and cemiplimab are important for dose escalation and PoC trial success. Quantitative or semi-quantitative biomarkers can help establish the correlation of dose level with target expression, PDy, and PK parameters, and aid in determination of the MTD/MAD. The biomarkers for the cytokine RNA mixture monotherapy and cytokine RNA mixture/cemiplimab combination therapy programs can be broadly classified into circulating target expression, PDy/safety markers, and the tissue derived PDy markers.
When possible, PDy sample collection coincide with scheduled PK sampling.
Systemic levels of the four target cytokines (IL-12sc, IL-15sushi, GM-CSF, and IFNα2b) translated from the cytokine RNA mixture and their downstream PDy targets (IFNγ and IFNγ-induced protein 10 [IP10]), and cemiplimab in plasma are monitored retrospectively in each participant cohort.
The safety biomarkers CRP and ferritin are used along with clinical parameters (e.g., fever, nausea, fatigue, headache, myalgias, malaise, hypoxia, hypotension) to assist in identification of clinical AEs. Samples are collected for monitoring of secondary CRS. A panel of 6 cytokines (IL-1β, IL-2, IL-6, IL-8, IL-10, and TNFα) are assessed retrospectively during the conduct of the study only in case of development of CRS Grade ≥2 symptoms. Samples are collected for combination therapy to monitor for potential autoimmunity; ANA, RF, TSH, and free T4 are assessed retrospectively for the combination therapy portion of the study.
Mandatory tumor biopsies are collected before the first IMP administration, between weeks 5 and 8, and at Cycle 6 or upon disease progression (whichever occurs first). For on-treatment biopsy specimens (i.e., the one at week 5-8, and the other one at Cycle 6 or at the time of disease progression), it is required to get biopsy specimens from both injected and un-injected lesions. Preferably, one of the lesions to be biopsied on-treatment should be the one that has been biopsied at baseline. If this is not feasible, tissue specimen from another injected lesion could be considered. If there is a limitation of lesions to be biopsied, then biopsy of only the un-injected lesion could be considered if another sample from the same site has been previously collected or could be collected at the following sampling time point.
Biopsies for all participants undergo hematoxylin and eosin staining and standard IHC for CD3, CD8, and tumor cells will be determined by SOX10 markers (for melanoma) or pancytokeratin ([CK] for patients with epithelial tumors HNSCC and CSCC) and lymphoma markers in respect to the tumor type interrogated; the standard IHC also includes CD68 and PD-L1 for the combination therapy cohorts. A subset of participant biopsies (from both responders and non-responders) undergo a 12 marker multiplex IHC. For the monotherapy part of the study, the multiplex panel consists of CD3, CD4, CD8, CD38, CD45, CD45RO, CD56, CD68, FoxP3, PD-1, PD-L1, and SOX10 or PanCK or lymphoma markers. For the combination therapy part of the study, the multiplex panel consists of CD3, CD4, CD8, CD38, CD56, CD68, granzyme B (GZMB), colony stimulating factor 1 receptor (CSF-1R), lymphocyte-activation gene 3 (LAG-3), PD-1, PD-L1, and SOX10 (for melanoma) or PanCK (for patients with epithelial tumors HNSCC and CSCC) or lymphoma markers. IHC on pre- and post-treatment biopsies is collected and used to assess changes in the tumor microenvironment, specifically assessing the frequency and density of infiltrating T-cells in the tumor and stroma. Increases in T-cells between pre- and post-biopsies are a positive immune correlate used to help define proof of mechanism.
For melanoma patients only during expansion of both monotherapy and combination therapy, a single tumor core biopsy performed between weeks 5-8 will be dedicated for TILs isolation. This will be applied to a limited number (e.g., no more than ten patients with successful TILs isolation) of selected melanoma patients. This will not be an additional biopsy, but instead the sample dedicated for genomic assessment will be used for TILs isolation (handled under special conditions—not formalin fixed). This kind of sample and testing is applied to patients with clinical signs of response to treatment (tumor size reduction and/or redness at the tumor site) as determined by the treating investigator.
Tumor transcriptomics (RNA Sequencing) genomics, and neo-antigens are also analyzed upon sample availability.
Several analyses are conducted to analyze genomics in the context of treatment, including somatic mutations and HLA typing on PBMCs; RNA sequencing (RNAseq) on tumors; RNAseq on blood (only for combination therapy). Tumor transcriptomic and genomic analyses may also be performed upon sample availability. Tumor RNAseq data (also planned as part of the biomarker analysis) are required to determine gene signatures, neo-antigens within tumor, TMB, and TCR diversity. HLA typing will be performed in blood. Participation in these analyses is mandatory if adequate sample material is available.
For the monotherapy portion of the study, neo-antigens are assessed only in melanoma participants. For the combination therapy portion of the study, neo-antigens will only be assessed at the expansion phase for participants of Cohort A (PD-1/PD-L1 refractory).
In the event of DNA or RNA extraction failure, a replacement sample (tumor or blood) is requested from the participant. Signed informed consent is required to obtain a replacement sample unless it was included in the original consent. In case of feasibility constraints on sample handling and shipment, samples from related clinical sites will not be assessed for these (or some of these) analyses.
Antibodies to the cytokine RNA mixture-encoded cytokines are evaluated for both the monotherapy and combination therapy, whereas antibodies to cemiplimab are evaluated in the combination therapy cohorts.
Antibodies to the cytokine RNA mixture-encoded cytokines are evaluated in plasma samples collected from all participants according to the SOA. Additionally, plasma samples are also collected at the final visit from participants who discontinued study intervention or were withdrawn from the study. These samples are tested by the Sponsor or Sponsor's designee. Antibodies to cemiplimab are evaluated in serum samples. The samples for ADAs against cemiplimab are tested.
Plasma samples are screened for antibodies binding to each of the four expressed cytokines from the cytokine RNA mixture and the titer of confirmed positive samples is reported. Other analyses are performed to further characterize the immunogenicity of the cytokine RNA mixture.
The detection and characterization of antibodies to the cytokine RNA mixture are performed using a validated assay method by or under the supervision of the Sponsor. Antibodies are further characterized and/or evaluated for their ability to neutralize the activity of the study intervention. Samples are stored for a maximum of 5 years (or according to local regulations) following the last participant's last visit for the study at a facility selected by the Sponsor to enable further analysis of immune responses to the cytokine RNA mixture and/or cemiplimab.
Exploratory transcriptome studies are conducted using microarray, and/or alternative equivalent technologies, which facilitates the simultaneous measurement of the relative abundances of thousands of RNA species resulting in a transcriptome profile for each tissue biopsy sample. Tumor tissue remaining after IHC is subject to RNA sequencing analysis to assess global gene expression changes within the tumor environment, in particular looking for development of pro-inflammatory and/or IFNγ gene signatures. This enables the evaluation of changes in transcriptome profiles that correlate with an adaptive immune response relating to the action of the cytokine RNA mixture and/or cemiplimab.
The same samples are also used to confirm findings by application of alternative technologies.
The same RNAseq analysis is done in blood samples during the combination therapy part of the study.
Dose Escalation
There is no formal statistical hypothesis in the dose escalation phase of this study. This study aims to establish the MTD or MAD of the cytokine RNA mixture according to DLTs observed. Dose escalation proceeds using a single-participant dose escalation for the first two DLs followed by a rational design.
For combination therapy with cemiplimab, this study aims to establish the MTD or MAD of the cytokine RNA mixture in combination with cemiplimab according to DLTs observed. Dose escalation proceeds using a rational design.
Dose Expansion
For monotherapy, the null hypothesis is that the true ORR per RECIST 1.1 is ≤10%, and the alternative hypothesis is that the true ORR per RECIST 1.1 is ≥26%.
For combination therapy:
A total of up to 72 participants are enrolled when the cytokine RNA mixture is administered as a single agent, depending on the investigated dose levels during the escalation phase. A total of up to 192 participants are enrolled when the cytokine RNA mixture is administered in combination with cemiplimab, depending on the investigated dose levels during the escalation phase and the completed stages for each cohort during the expansion phase. The maximum number of patients to be enrolled in the study is expected to be up to 264 patients, as described in further detail in the following sections.
Dose Escalation Phase
There is no formal sample size calculation in the monotherapy dose escalation phase. Approximately 38 DLT-evaluable participants are enrolled in the dose escalation phase with assessment of about 8 DLs. The actual sample size varies depending on DLTs observed and number of dose levels actually explored.
For combination therapy, the actual sample size in the dose escalation of the cytokine RNA mixture in combination with cemiplimab varies depending on DLTs observed and number of dose levels actually explored (approximately 18 to 36 DLT-evaluable participants).
Dose Expansion Phase
A rational design is used in the monotherapy dose expansion phase. The null hypothesis that the true response rate is 10% is tested against a one-sided alternative. In the first stage, 16 participants are accrued. If there are 1 or fewer responses, according to RECIST 1.1 criteria, in these 16 participants, the study is stopped. Otherwise, 18 additional participants are accrued for a total of 34. The null hypothesis is rejected if 7 or more responses are observed in 34 participants with advanced melanoma that have failed a prior therapy based on anti-PD-1 or anti-PD-L1. This design yields a one-sided type I error rate of 5% and power of 80% when the true response rate is 26%.
The sample size for the combination therapy expansion phase is calculated based on a rational design with 1-sided alpha level of 5% and 85% power; approximately 156 participants with advanced solid tumors are expected to be enrolled. The assumption of ORR, the required sample sizes, and the required number of responders at each stage are provided in Table 15:
For purposes of analysis, the following populations are defined as shown in Table 16:
Efficacy Analyses
Objective response rate (ORR) per RECIST 1.1 based on pre-selected lesions, including injected and un-injected lesions, are summarized with descriptive statistics. A 90% two-sided confidence interval is computed using Clopper-Pearson method. The statistical inference is based on the hypothesis and alpha level defined in the sample size calculation section. A similar analysis is provided for the DCR per RECIST 1.1 and iRECIST, and the ORR per iRECIST. In addition, a summary of tumor burden change is provided for injected and un-injected lesions separately as a supportive analysis. DoR and PFS are summarized using the Kaplan-Meier method.
Safety Analyses
All safety analyses will be performed on the all-treated population.
Dose-Limiting Toxicities
In the dose escalation phase (monotherapy and combination therapy), DLTs are summarized by monotherapy and combination therapy and dose level. Details of DLTs are provided by the participant. DLTs are defined using NCI CTCAE version 5.0, as described above.
Analyses of Adverse Events
The observation period is divided into 3 segments: screening, TEAE and post-treatment. The screening period is defined as the time informed consent is signed until the administration of the first dose of study intervention. The treatment-emergent adverse event (TEAE) period is defined as the time from the first dose of study interventions up to 30 days after last dose of study interventions. The post-treatment period is defined as the time starting 31 days after the last dose of study interventions to study closure or death, whichever comes first.
Pre-treatment AEs are defined as any AE during the screening period. Treatment-emergent AEs are defined as AEs that develop, worsen (according to the Investigator opinion) or become serious during the TEAE period. Post-treatment AEs are defined as AEs that are reported during the post-treatment period. The primary focus of AE reporting is on TEAEs. Pre-treatment and post-treatment AEs are described separately.
The TEAEs are coded according to Medical Dictionary for Regulatory Activities (MedDRA). AEs are graded according to the NCI CTCAE version 5.0. The grade is considered in the summary. For participants with multiple occurrences of the same preferred term (PT), the maximum grade is used.
An overall summary of TEAEs is provided. The number and percentage of participants who experience any of the following are provided:
The number and percentage of participants experiencing TEAEs by primary system organ class (SOC) and PT are summarized by NCI CTCAE grade (all grades and Grade ≥3). Similar tables are prepared for treatment-related TEAEs, AESIs, TEAEs leading to treatment discontinuation, TEAEs leading to dose modification, serious TEAEs, TEAEs with fatal outcome and AEs/SAEs occurring during the post-treatment dosing period. Immune-related AEs (irAEs), as a subset of treatment-related TEAEs after study intervention, are summarized for the monotherapy and combination parts of the study separately.
Clinical Laboratory Evaluations
Clinical laboratory results are graded according to NCI CTCAE version 5.0, when applicable. Number (%) of participants with laboratory abnormalities (i.e., all grades and Grade ≥3) using the worst grade during the TEAE period is provided for the all-treated population.
As explained above, not all transient changes in laboratory values based on mode of action are documented as TEAEs; the Investigator evaluates whether a laboratory change is clinically relevant in order to document it as a TEAE.
When the NCI CTCAE version 5.0 scale is not applicable, the number of participants with laboratory abnormality out-of-normal laboratory range value is displayed.
The tests detailed in Tables 19 and 20 performed and the results are entered into the eCRF. Protocol-specific requirements for inclusion or exclusion of participants are detailed in the protocol. Additional tests are performed at any time during the study as determined necessary by the Investigator or required by local regulations. Investigators must document their review of each laboratory safety report.
aDetails of liver chemistry stopping criteria and required actions and follow-up assessments after liver stopping or monitoring event are given below. All events of ALT ≥ 3 × upper limit of normal (ULN) and bilirubin ≥ 2 × ULN (>35% direct bilirubin) or ALT ≥ 3 × ULN and international normalized ratio (INR) > 1.5, if INR measured which may indicate severe liver injury (possible Hy's Law) must be reported as an SAE.
aFor combination therapy, these assessments will be made in Cohort A (participants with melanoma who have failed anti-PD-1/PD-L1 therapy) only.
bTMB will be assessed in combination therapy portion of the study. This analysis can be considered for patients in monotherapy on remaining sample.
cSee Example 1.8B for a description of the single and multiplex IHC panels to be assessed in the monotherapy and combination therapy portions of the study.
dSOX10 is a marker for detection of melanoma tumor cells; for epithelial tumors (HNSCC and CSCC) it will be replaced by pancytokeratin (CK).
Woman of childbearing potential (WOCBP): A woman of childbearing potential is a woman who:
1. has achieved menarche at some time point,
2. has not undergone a hysterectomy or bilateral oophorectomy, or
3. has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months).
Contraception Guidance
Highly effective contraceptive methods that are user dependent: Failure rate of <1% per year when used consistently and correctly.
Highly effective methods that are user independent:
Vasectomized partner: A vasectomized partner is a highly effective contraception method provided that the partner is the sole male sexual partner of the WOCBP and the absence of sperm has been confirmed. If not, an additional highly effective method of contraception is used.
Sexual abstinence: Sexual abstinence is considered a highly effective method only if defined as refraining from heterosexual intercourse during the entire period of risk associated with the study intervention. The reliability of sexual abstinence is evaluated in relation to the duration of the study and the preferred and usual lifestyle of the participant.
NOTES: Typical use failure rates may differ from those when used consistently and correctly. Use should be consistent with local regulations regarding the use of contraceptive methods for participants participating in clinical studies. Hormonal contraception may be susceptible to interaction with the study intervention, which may reduce the efficacy of the contraceptive method. In this case, two highly effective methods of contraception are utilized during the intervention period and for at least 6 months after the last dose of study intervention. Oral hormonal contraception may be susceptible to interaction with the study intervention, which may reduce the efficacy of the contraceptive method. In this case, if the oral contraceptive cannot be replaced by another highly effective method of contraception with a different route of administration, the hormonal contraception method must be supplemented with a male condom (for partner) during the intervention period and for at least 6 months after the last dose of study intervention.
PREGNANCY TESTING: WOCBP is included only after a confirmed menstrual period and a negative highly sensitive serum pregnancy test. Additional pregnancy testing is performed at the beginning of each treatment cycle during the intervention period and at EOT. Pregnancy testing is performed whenever a menstrual cycle is missed or when pregnancy is otherwise suspected. Pregnancy testing is performed according to local lab procedure. Any female participant who becomes pregnant while participating in the study is to discontinue study intervention and is withdrawn from the study.
Collection of Pregnancy Information:
Male participants with partners who become pregnant—The Investigator attempts to collect pregnancy information on any male participant's female partner who becomes pregnant while the male participant is in this study. This applies only to male participants who receive the cytokine RNA mixture. After obtaining the necessary signed informed consent from the pregnant female partner directly, the Investigator records pregnancy information on the appropriate form and submits it to the Sponsor within 24 hours of learning of the partner's pregnancy. The female partner is also be followed to determine the outcome of the pregnancy. Information on the status of the mother and child is forwarded to the Sponsor. Generally, the follow-up will be no longer than 6 to 8 weeks following the estimated delivery date. Any termination of the pregnancy will be reported regardless of fetal status (presence or absence of anomalies) or indication for the procedure.
Female participants who become pregnant—The Investigator collects pregnancy information on any female participant who becomes pregnant while participating in this study. Information is recorded on the appropriate form and submitted to the Sponsor within 24 hours of learning of a participant's pregnancy. The participant is followed to determine the outcome of the pregnancy. The Investigator will collect follow-up information on the participant and the neonate and the information will be forwarded to the Sponsor. Generally, follow-up is not required for longer than 6 to 8 weeks beyond the estimated delivery date. Any termination of pregnancy is reported, regardless of fetal status (presence or absence of anomalies) or indication for the procedure. Any pregnancy complication or elective termination of a pregnancy is reported as an AE or SAE. A spontaneous abortion is always considered to be an SAE and will be reported as such. Any post-study pregnancy related SAE considered reasonably related to the study intervention by the Investigator is reported to the Sponsor. While the Investigator is not obligated to actively seek this information in former study participants, he or she may learn of an SAE through spontaneous reporting.
Any female participant becoming pregnant while participating in the study discontinues the study intervention and is withdrawn from the study.
Symptoms, Grading, and Management of CRS
Clinical signs and symptoms associated with CRS
Grading and Management of CRS is provided in Table 22.
Guidance for Other AEs
Table 23 provides guidelines for uveitis management; note that all attempts are made to rule out other causes such as metastatic disease, infection, or other ocular disease (e.g., glaucoma or cataracts).
Table 24 provides guidance and supportive care strategies for the management of adverse events that are attributed to the cytokine RNA mixture.
In addition, specifically for the combination part of the study, in case the reported AE is considered as related to one IMP, the related IMP and continue study intervention with the other IMP is stopped, based on available data from the monotherapy portion of the study, and if continuation of the IMP is considered as the best option for the participant based on a current case-by-case benefit-risk assessment. For management of irAE that might be considered to be related to cemiplimab, the cemiplimab IB and the National Comprehensive Cancer Network (NCCN) guidance on “Management of Immunotherapy-Related Toxicities (Immune Checkpoint Inhibitor-Related Toxicities)” is followed (available at www.nccn.org).
For participants with severe irAE not responsive to steroid within 48-72 hours, early (i.e., within 72 hours) initiation of anti-TNFα therapy may be warranted by consultation with the relevant medical specialist.
Details provided in Eisenhauer E A, Therasse P, Bogaerts J, Schwartz L H, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009 January; 45(2):228-47.
Measurability of Tumor at Baseline
At baseline, tumor lesions/lymph nodes are categorized measurable or non-measurable as follows.
Measurable lesions are accurately measured in at least 1 dimension (longest diameter in the plane of the measurement to be recorded) with a minimum size of:
Malignant lymph nodes: To be considered pathologically enlarged and measurable, a lymph node must be ≥15 mm in short axis when assessed by CT scan (CT scan slice thickness recommended to be no greater than 5 mm). At baseline and in follow-up, only the short axis is measured and followed.
Non-measurable lesions are all other lesions, including small lesions (longest diameter <10 mm or pathological lymph nodes with ≥10 to <15 mm short axis), as well as non-measurable lesions. Lesions considered non-measurable include: leptomeningeal disease, ascites, pleural or pericardial effusion, inflammatory breast disease, lymphangitic involvement of skin or lung, abdominal masses/abdominal organomegaly identified by physical exam that is not measurable by reproducible imaging techniques.
Special Considerations Regarding Lesion Measurability:
Bone Lesions:
Cystic Lesions:
Lesions with Prior Local Treatment:
Method of Assessment
All measurements are recorded in metric notation, using calipers if clinically assessed. All baseline evaluations are performed as close as possible to the treatment start and never more than 4 weeks before the beginning of the treatment.
The same method of assessment and the same technique are used to characterize each identified and reported lesion at baseline and during follow-up. Imaging based evaluation is always performed rather than clinical examination unless the lesion(s) being followed cannot be imaged but are assessable by clinical examination.
Clinical lesions: Clinical lesions are only considered measurable when they are superficial and ≥10 mm diameter as assessed using calipers. For the case of skin lesions, documentation by color photography including a ruler to estimate the size of the lesion is suggested. As noted above, when lesions can be evaluated by both clinical exam and imaging, imaging evaluation is undertaken since it is more objective and may be reviewed at the end of the study.
Chest X-ray: Chest CT is preferred over chest X-ray, particularly when progression is an important endpoint, since CT is more sensitive than X-ray, particularly in identifying new lesions. However, lesions on chest X-ray are considered measurable if they are clearly defined and surrounded by aerated lung.
CT, MRI: CT is the best currently available and reproducible method to measure lesions selected for response assessment. Measurability of lesions on CT scan is based on the assumption that CT slice thickness is 5 mm or less. When CT scans have slice thickness greater than 5 mm, the minimum size for a measurable lesion should be twice the slice thickness.
Ultrasound: Ultrasound is not useful in assessment of lesion size and should not be used as a method of measurement. If new lesions are identified by ultrasound in the course of the study, confirmation by CT or MRI is advised.
Endoscopy, laparoscopy: The utilization of these techniques for objective tumor evaluation is not advised.
Tumor markers: Tumor markers alone cannot be used to assess objective tumor response.
Cytology, histology: These techniques can be used to differentiate between PR and CR in rare cases if required by protocol.
FDG PET-CT/CT scans: Performed in lymphoma patients approximately every 12 weeks to confirm CR or PD.
Baseline Documentation of ‘Target’ and ‘Non-Target’ Lesions
When more than 1 measurable lesion is present at baseline all lesions up to a maximum of 5 lesions total (and a maximum of 2 lesions per organ) representative of all involved organs should be identified as target lesions and will be recorded and measured at baseline.
Target lesions are selected based on their size (lesions with the longest diameter), are representative of all involved organs, and lend themselves to reproducible repeated measurements.
Lymph nodes merit special mention since they are normal anatomical structures which may be visible by imaging even if not involved by tumor. Pathological nodes which are defined as measurable and may be identified as target lesions must meet the criterion of a short axis of ≥15 mm by CT scan. Only the short axis of these nodes contributes to the baseline sum. All other pathological nodes (those with short axis ≥10 mm but <15 mm) should not be considered non-target lesions. Nodes that have a short axis <10 mm are considered non-pathological and should not be recorded or followed.
A sum of the diameters (longest for non-nodal lesions, short axis for nodal lesions) for all target lesions is calculated and reported as the baseline sum diameters. The baseline sum diameters are used as reference to further characterize any objective tumor regression in the measurable dimension of the disease.
All other lesions (or sites of disease) including pathological lymph nodes are identified as non-target lesions and are also recorded at baseline. Measurements are not required, and these lesions are followed as “present”, “absent”, or “unequivocal progression”. In addition, it is possible to record multiple non-target lesions involving the same organ as a single item on the case (e.g., “multiple enlarged pelvic lymph nodes” or “multiple liver metastases”).
Response criteria are described in Table 25.
Special Notes on the Assessment of Target Lesions
Lymph nodes identified as target lesions always have the actual short axis measurement recorded and are measured in the same anatomical plane as the baseline examination, even if the nodes regress to below 10 mm on study. This means that when lymph nodes are included as target lesions, the ‘sum’ of lesions may not be zero even if CR criteria are met, since a normal lymph node is defined as having a short axis of <10 mm. For PR, SD and PD, the actual short axis measurement of the nodes is to be included in the sum of target lesions.
Target lesions that become ‘too small to measure’: All lesions (nodal and non-nodal) recorded at baseline should have their actual measurements recorded at each subsequent evaluation, even when very small (e.g., 2 mm). However, sometimes lesions or lymph nodes which are recorded as target lesions at baseline become so faint on CT scan that the radiologist may not feel comfortable assigning an exact measure and may report them as being ‘too small to measure’. When this occurs, it is important that a value is recorded on the CRF. If it is the opinion of the radiologist that the lesion has likely disappeared, the measurement is recorded as 0 mm. If the lesion is believed to be present and is faintly seen but too small to measure, a default value of 5 mm is assigned.
When non-nodal lesions ‘fragment’, the longest diameters of the fragmented portions are added together to calculate the target lesion sum. Similarly, as lesions coalesce, a plane between them is maintained that would aid in obtaining maximal diameter measurements of each individual lesion. If the lesions have truly coalesced such that they are no longer separable, the vector of the longest diameter in this instance is the maximal longest diameter for the “coalesced lesion”.
Evaluation of Non-Target Lesions
While some non-target lesions may be measurable, they need not be measured and instead are assessed only qualitatively at the time points specified in the protocol.
CR: Disappearance of all non-target lesions and normalization of tumor marker level. All lymph nodes must be non-pathological in size (<10 mm short axis).
Non-CR/Non-PD: Persistence of 1 or more non-target lesion(s) and/or maintenance of tumor marker level above the normal limits.
Progressive Disease: Unequivocal progression of existing non-target lesions. (Note: the appearance of 1 or more new lesions is also considered progression).
The concept of progression of non-target disease requires additional explanation as follows:
When the participant also has measurable disease; in this setting, to achieve “unequivocal progression” based on the non-target disease, there must be an overall level of substantial worsening in non-target disease such that, even in presence of SD or PR in target disease, the overall tumor burden has increased sufficiently to merit discontinuation of therapy. A modest “increase” in the size of 1 or more non-target lesions is usually not sufficient to qualify for unequivocal progression status.
When the participant has only non-measurable disease; to achieve ‘unequivocal progression’ based on the non-target disease, there must be an overall level of substantial worsening such that the overall tumor burden has increased sufficiently to merit discontinuation of therapy. A modest ‘increase’ in the size of 1 or more non-target lesions is usually not sufficient to qualify for unequivocal progression status. Because worsening in non-target disease cannot be easily quantified (by definition: if all lesions are truly non-measurable) a useful test that can be applied when assessing patients for unequivocal progression is to consider if the increase in overall disease burden based on the change in non-measurable disease is comparable in magnitude to the increase that would be required to declare PD for measurable disease: i.e., an increase in tumor burden representing an additional 73% increase in ‘volume’ (which is equivalent to a 20% increase diameter in a measurable lesion). Examples include an increase in a pleural effusion from ‘trace’ to ‘large’, an increase in lymphangitic disease from localized to widespread, or may be described in protocols as ‘sufficient to require a change in therapy’. If ‘unequivocal progression’ is seen, the patient is considered to have had overall PD at that point.
New Lesions
The appearance of new malignant lesions denotes disease progression. The finding of a new lesion should be unequivocal: i.e., not attributable to differences in scanning technique, change in imaging modality or findings thought to represent something other than tumor (for example, some ‘new’ bone lesions may be simply healing or flare of pre-existing lesions). This is particularly important when the participant's baseline lesions show PR or CR. For example, necrosis of a liver lesion may be reported on a CT scan report as a ‘new’ cystic lesion, which it is not.
A lesion identified on a follow-up study in an anatomical location that was not scanned at baseline is considered a new lesion and indicates disease progression. An example of this is the patient who has visceral disease at baseline and while on study has a CT or MM brain ordered which reveals metastases. The participant's brain metastases are considered to be constitute PD even if he/she did not have brain imaging at baseline.
If a new lesion is equivocal, for example because of its small size, continued therapy and follow-up evaluation clarifies if it represents new disease. If repeat scans confirm that there is a new lesion, then progression is declared using the date of the initial scan.
While fluorodeoxyglucose-positron emission tomography (FDG-PET) response assessments need additional study, it is sometimes reasonable to incorporate the use of FDG-PET scanning to complement CT scanning in assessment of progression (particularly possible ‘new’ disease). New lesions based on FDG-PET imaging are identified according to the following algorithm:
Evaluation of Best Overall Response
Time point response: At each protocol specified time point, a response assessment should occur. Table 26 provides a summary of the overall response status calculation at each time point for patients who have measurable disease at baseline.
When patients have non-measurable (therefore non-target) disease only, Table 27 is to be used.
Missing assessments and inevaluable designation: When no imaging/measurement is done at all at a particular time point, the patient is not evaluable (NE) at that time point.
If only a subset of lesion measurements is made at an assessment, usually the case is also considered NE at that time point, unless a convincing argument can be made that the contribution of the individual missing lesion(s) would not change the assigned time point response. This would be most likely to happen in the case of PD. When no imaging/measurement is done at all at a particular time point, the patient is NE at that time point.
If only a subset of lesion measurements is made at an assessment, usually the case is also considered NE at that time point, unless a convincing argument can be made that the contribution of the individual missing lesion(s) would not change the assigned time point response. This would be most likely to happen in the case of PD.
Special Notes on Response Assessment
When nodal disease is included in the sum of target lesions and the nodes decrease to ‘normal’ size (<10 mm), they may still have a measurement reported on scans. This measurement is recorded even though the nodes are normal in order not to overstate progression should it be based on increase in size of the nodes. As noted earlier, this means that patients with CR may not have a total sum of ‘zero’ on the CRF.
In trials where confirmation of response is required, repeated ‘NE’ time point assessments may complicate best response determination. The analysis plan for the trial must address how missing data/assessments are addressed in determination of response and progression. For example, in most trials it is reasonable to consider a patient with time point responses of PR-NE-PR as a confirmed response.
Patients with a global deterioration of health status requiring discontinuation of treatment without objective evidence of disease progression at that time are reported as ‘symptomatic deterioration’. Every effort should be made to document objective progression even after discontinuation of treatment. Symptomatic deterioration is not a descriptor of an objective response: it is a reason for stopping study therapy.
The objective response status of such patients is determined by evaluation of target and non-target disease. For equivocal findings of progression (e.g., very small and uncertain new lesions; cystic changes or necrosis in existing lesions), treatment may continue until the next scheduled assessment. If at the next scheduled assessment, progression is confirmed, the date of progression is the earlier date when progression was suspected.
Duration of Response
The duration of overall response is measured from the time measurement criteria are first met for CR/PR (whichever is first recorded) until the first date that recurrent or PD is objectively documented (taking as reference for PD the smallest measurements recorded on study).
The duration of overall CR is measured from the time measurement criteria are first met for CR until the first date that recurrent disease is objectively documented.
Stable disease is measured from the start of the treatment until the criteria for progression are met, taking as reference the smallest sum on study (if the baseline sum is the smallest, this is the reference for calculation of PD).
Non-limiting descriptions relating to the RECIST guidelines are provided in Eisenhauer E A, Therasse P, Bogaerts J et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer. 2009; 45:228-47, the entire contents of which are incorporated herein by reference.
Details are provided in Seymour L, Bogaerts J, Perrone A, Ford R, Schwartz L H, Mandrekar S, et al. iRECIST: guidelines for response criteria for use in trials testing immunotherapeutics. Lancet Oncol. 2017 March; 18(3):e143-52.
aPreviously identified in assessment immediately before this timepoint.
aClinically occult are diagnosed after sentinel or elective lymphadenectomy.
bClinically detected are defined as clinically detectable nodal metastases confirmed by therapeutic lymphadenectomy or when nodal metastasis exhibits gross extracapsular extension.
Disease response will be assessed using the Lugano classification 2014 (Cheson B D et al. (2014) J. Clinical Oncology 32(27)3059-3068). Response assessments occur at Screening and every 12 weeks (±7 days).
Imaging timing should follow calendar days and should not be adjusted for delays in cycle. For participants who discontinue for reasons other than PD, assessments should continue until the participant has documented PD. The first assessment may be performed earlier than 12 weeks if in the opinion of the Investigator the participant is clinically progressing.
Mouse Model for Acquired Resistance to Anti-PD1 Therapy
A mouse tumor model exhibiting acquired resistance to anti-PD-1 antibody treatment was generated essentially as follows. See, also, Dunn et al. (2002) Nature Immunology 3: 991-998; and Wang X et al. (2017) Cancer Res 77(4): 839-850. Female C57BL6/J mice (Jackson Laboratory, Bar Harbor, Me., USA) bearing MC38 tumors were treated with an anti-PD-1 antibody (clone RMP1-14; as first described in Yamazaki et al. (2005) J Immunol 175(3): 1586-1592 at methods), growing tumors were excised, and cells were cultured ex vivo in RPMI-1640 with L-glutamine (Life Technologies) supplemented with 10% FBS. Female C57BL6/J mice aged 6 to 8 weeks were housed in a temperature controlled environment on 12 hour light cycle with free access to food and sterile water. All mice were acclimated for at least 3 days prior to experimentation. Body weight and tumor volume, if measured, were measured twice weekly until the experimental endpoints. Tumor volume is expressed as the product of the perpendicular diameters using the following formula: a2*b/2, where a<b.
For
In Vivo Drug Administration
Four doses of mouse cytokine mRNA mixture or control mRNA encoding luciferase (Luc mRNA) were administered every four days (Q4D) by intratumoral (IT) injection at 40 μg in 50 μl per tumor starting when tumors reached an average of 60 mm3. Mouse body weight and tumor volume were measured twice weekly until the experimental endpoints. Tumor volume was expressed as the product of perpendicular diameters using the following formula: a2*b/2, where a<b. All procedures were approved by an Institutional Animal Care and Use Committee and were conducted in accordance with the NIH Guide for the Care and Use of Laboratory Animals.
Preparation of mRNA
Synthetic DNA fragments coding for the gene of interest were cloned into a common starting vector, comprising a 5′-untranslated region (UTR) and 3′ UTR, a 3′ UTR, and a poly(A)-tail of 110 nucleotides in total. Linearization of plasmid DNA was performed downstream of the poly(dA:dT) with a classIIS restriction enzyme to generate a template with no additional nucleotides beyond poly(dA:dT) (See, e.g., Holtkamp et al. (2006) Blood December 15; 108(13):4009-17). Linearized plasmid DNA was subjected to in vitro transcription with T7 RNA polymerase (Thermo Fisher, Waltham Mass., USA) as described by Grudzien-Nogalska et al (2013) Methods Mol Bio. 969:55-72, in the presence of 7.5 mM ATP, CTP, GTP, and N1-methyl-pseudouridinetriphosphate. RNA was purified using magnetic particles (Berensmeier S. (2006) Applied Microbiology and Biotechnology 73(3):495-504) and subsequently a Cap1 structure was introduced using the Vaccinia Capping system (New England Biolabs, Ipswich, Mass., USA) and 2′-O-methylation of the mRNA cap. The RNA was further purified using cellulose-based chromatography to remove double-stranded RNA (dsRNA) impurities (see Day P R et al (1977) Phytopathology 67:1393; Morris T J et al. (1979) Phytopathology 69:854-858; and Castillo A et al. (2011) Virol J. 8:38). RNA concentration and quality were assessed using spectrophotometry and capillary gel electrophoresis systems. Presence of dsRNA was assessed in a Northwestern dot-blot assay using dsRNA-specific J2 mAb (English & Scientific Consulting, KFt. Szirák, Hungary) as described by Karikó et al (2011) Nucleic Acids Res. November; 39(21): e142.
Results
Several mechanisms of innate and acquired resistance to checkpoint blockade have been defined and include mutations of MHC I and IFNγ signaling pathways. See, for example, Sharma et al. (2017) Cell 168(4):707-723; Sade-Feldman M et al. (2017) Nat Commun 8(1):1136; Zaretsky J M et al. (2016) N Engl J Med 375(9): 819-29; Gettinger S. et al. (2017) 7(12): 1420-1435; Rodig S J et al. (2018) Sci Transl Med 10(450). However, such mutations occur in a low frequency of patients and additional mechanisms have yet to be defined. In an effort to better understand acquired resistance to checkpoint blockade, we generated a mouse tumor model exhibiting in vivo resistance to anti-PD-1 antibody treatment. MC38 tumors acquired resistance to PD-1 blockade following serial in vivo passaging (
Further validation of the model was performed and the results are shown in
Using this validated model, cytokine RNA mixture was administered intratumorally as monotherapy. Monotherapy with murine cytokine RNA mixture inhibited the growth of both MC38 and MC38-resistant tumors as compared to control. See,
MC38 cells, a gift from Dr. S. A. Rosenberg (National Institute of Health, Bethesda, Md., USA), were cultured in RPMI-1640 with L-glutamine (Life Technologies) supplemented with 10% FBS. In general, for the single flank tumor model, MC38 cells were suspended in DPBS and 1×106 cells in 200 μl were implanted SC into the right flank of C57BL/6J mice. In general, for the dual flank tumor MC38 model, 1×106 cells on the right side and 0.5×106 cells on the left side were implanted SC on day 0.
To generate an in vivo tumor model of resistance to anti-PD-1 therapy, MC38-B2M-knockout cells were generated using CRISPR using the sgRNA 5′-GGCGTATGTATCAGTCTCAG-3′ (SEQ ID NO: 41). MC38 cells were transiently transfected (Lipofectamine™ CRISPRMAX™; ThermoFisher Scientific, Waltham, Mass., USA) with pre-complexed Cas9 and sgRNA (GeneArt™ Platinum™ Cas9 Nuclease V.2; ThermoFisher Scientific) according to the manufacturer's instructions. B2M−/− cells were enriched using MACS technology (Miltenyi Biotec, Bergisch Gladbach, Germany), then single cell colonies were isolated and knockout confirmed by flow cytometry.
In Vivo Drug Administration
Cytokine RNA mixture was administered by intratumoral injection. Mice were anesthetized with isoflurane and 80 μg in 50 μl mRNA in saline solution injected intratumorally (IT) into the right tumor every 4 days for four doses total unless detailed otherwise. Antibodies were obtained from BioXCell (West Lebanon, N.H., USA) unless otherwise noted and administered by IP injection. Control (MOPC-21) and anti-PD-1 (RMP1-14) were administered at a dose of 5 mg/kg every three days (Q3D).
Results
To investigate therapeutic efficacy of cytokine mRNA treatment in a checkpoint resistant setting, B2M was genetically deleted in MC38 cells (
To model the intertumoral heterogeneity often observed in human malignancies, a dual flank setting was established with MC38-B2M knockout on one side and the MC38-WT tumors on the contralateral flank (
Materials and Methods
Twelve syngenic cell lines were maintained in vitro with different medium (shown below) at 37° C. in an atmosphere of 5% CO2 in air. The tumor cells will be routinely subcultured twice weekly. The cells in an exponential growth phase were harvested and counted for tumor inoculation. Each mouse was inoculated subcutaneously with tumor cells in 0.1 mL of PBS for tumor development. After tumor cells inoculation, the animals were checked daily for morbidity and mortality. During routine monitoring, the animals were checked for any effects of tumor growth and treatments on behavior such as mobility, food and water consumption, body weight gain/loss (Body weights would be measured twice per week after randomization), eye/hair matting and any other abnormalities. Mortality and observed clinical signs were recorded for individual animals in detail. Tumor volumes were measured twice per week after randomization in two dimensions using a caliper, and the volume was expressed in mm3 using the formula: V=(L×W×W)/2, where V is tumor volume, L is tumor length (the longest tumor dimension) and W is tumor width (the longest tumor dimension perpendicular to L). Dosing as well as tumor and body weight measurements were conducted in a Laminar Flow Cabinet. The body weights and tumor volumes were measured by using StudyDirector™ software (version 3.1.399.19).
To further understand the influence of tumor heterogeneity, twelve murine models were tested for sensitivity towards cytokine mRNA mixture or combinatorial treatment with an anti-PD-1 antibody. In contrast to the anti-PD1 antibody alone, most tumor types were sensitive to single-agent mRNA therapy. Furthermore, all models showed tumor growth deceleration upon combined treatment with cytokine mRNA and anti-PD1 (
| Number | Date | Country | Kind |
|---|---|---|---|
| EP19306471.4 | Nov 2019 | EP | regional |
This application is a Continuation of International Application No. PCT/US2020/014039, filed Jan. 17, 2020, which claims the benefit of priority to U.S. Provisional Application No. 62/794,896, filed Jan. 21, 2019, U.S. Provisional Application No. 62/926,379, filed Oct. 25, 2019, and European Patent Application No. 19306471.4, filed Nov. 14, 2019, the contents of each are incorporated by reference in their entireties for all purposes.
| Number | Date | Country | |
|---|---|---|---|
| 62926379 | Oct 2019 | US | |
| 62794896 | Jan 2019 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | PCT/US2020/014039 | Jan 2020 | US |
| Child | 17380251 | US |
